D Eldon Spackman1, David L Veenstra. 1. Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, Washington, USA.
Abstract
BACKGROUND: A variety of pharmaceuticals are currently approved for the treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB), but their relative economic value is unclear. The goal of this analysis was to compare the cost effectiveness of adefovir, entecavir, lamivudine, pegylated interferon and telbivudine. METHODS: We conducted a cost-utility analysis from a US payer perspective over a lifetime time horizon using a Markov model, in a hypothetical population with HBeAg-positive CHB and a mean age of 35 years. Disease progression probabilities, costs and quality-of-life data were derived from the literature. We assumed a treatment duration of 4 years, with the use of combination therapy for drug resistance. Nonresponders to pegylated interferon were assumed to receive entecavir in years 3-4. Sensitivity analyses, including probabilistic sensitivity analysis, were conducted to evaluate uncertainty in the results. All costs were valued in $US, year 2008 values. Costs and outcomes were discounted at 3% per annum. RESULTS: The 10-year cumulative incidence of cirrhosis for no treatment was 26.1%, and ranged from 19.7% to 23.8% with treatment; undiscounted life-years were 36.2 for no treatment, or ranged from 36.82 to 37.54 with treatment. Initiation with entecavir (18.70 QALYs) and pegylated interferon (18.64 QALYs) provided the largest treatment benefits overall, followed by telbivudine (18.55 QALYs). The probabilities of the interventions being cost effective at a threshold of USD 50,000 per QALY were 57%, 37% and 2% for initiation with entecavir, pegylated interferon and telbivudine, respectively. The results were dependent on baseline seroconversion rate and the effect of viral suppression on cirrhosis risk. CONCLUSIONS: Initiation of treatments for HBeAg-positive CHB with a favourable combination of seroconversion, viral suppression and resistance profile appear to offer the greatest clinical and economic value.
BACKGROUND: A variety of pharmaceuticals are currently approved for the treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB), but their relative economic value is unclear. The goal of this analysis was to compare the cost effectiveness of adefovir, entecavir, lamivudine, pegylated interferon and telbivudine. METHODS: We conducted a cost-utility analysis from a US payer perspective over a lifetime time horizon using a Markov model, in a hypothetical population with HBeAg-positive CHB and a mean age of 35 years. Disease progression probabilities, costs and quality-of-life data were derived from the literature. We assumed a treatment duration of 4 years, with the use of combination therapy for drug resistance. Nonresponders to pegylated interferon were assumed to receive entecavir in years 3-4. Sensitivity analyses, including probabilistic sensitivity analysis, were conducted to evaluate uncertainty in the results. All costs were valued in $US, year 2008 values. Costs and outcomes were discounted at 3% per annum. RESULTS: The 10-year cumulative incidence of cirrhosis for no treatment was 26.1%, and ranged from 19.7% to 23.8% with treatment; undiscounted life-years were 36.2 for no treatment, or ranged from 36.82 to 37.54 with treatment. Initiation with entecavir (18.70 QALYs) and pegylated interferon (18.64 QALYs) provided the largest treatment benefits overall, followed by telbivudine (18.55 QALYs). The probabilities of the interventions being cost effective at a threshold of USD 50,000 per QALY were 57%, 37% and 2% for initiation with entecavir, pegylated interferon and telbivudine, respectively. The results were dependent on baseline seroconversion rate and the effect of viral suppression on cirrhosis risk. CONCLUSIONS: Initiation of treatments for HBeAg-positive CHB with a favourable combination of seroconversion, viral suppression and resistance profile appear to offer the greatest clinical and economic value.
Authors: Fasiha Kanwal; Ian M Gralnek; Paul Martin; Gareth S Dulai; Mary Farid; Brennan M R Spiegel Journal: Ann Intern Med Date: 2005-05-17 Impact factor: 25.391
Authors: Emmet B Keeffe; Douglas T Dieterich; Steven-Huy B Han; Ira M Jacobson; Paul Martin; Eugene R Schiff; Hillel Tobias; Teresa L Wright Journal: Clin Gastroenterol Hepatol Date: 2006-07-14 Impact factor: 11.382
Authors: T Vassiliadis; N Nikolaidis; O Giouleme; K Tziomalos; N Grammatikos; K Patsiaoura; P Zezos; D Gkisakis; K Theodoropoulos; P Katsinelos; E Orfanou-Koumerkeridou; N Eugenidis Journal: Aliment Pharmacol Ther Date: 2005-03-01 Impact factor: 8.171
Authors: C L Lai; R N Chien; N W Leung; T T Chang; R Guan; D I Tai; K Y Ng; P C Wu; J C Dent; J Barber; S L Stephenson; D F Gray Journal: N Engl J Med Date: 1998-07-09 Impact factor: 91.245
Authors: Robert Perrillo; Hie-Won Hann; David Mutimer; Bernard Willems; Nancy Leung; William M Lee; Alison Moorat; Stephen Gardner; Mary Woessner; Eric Bourne; Carol L Brosgart; Eugene Schiff Journal: Gastroenterology Date: 2004-01 Impact factor: 22.682
Authors: Mandana Khalili; Nicole J Kim; Janice Y Tsoh; Judith M E Walsh; L Elizabeth Goldman; Ginny Gildengorin; Ching Wong; Mi T Tran; Edgar Yu; Michael Thanh Sharp; Vivian H LeTran; Vi-Van Nguyen; Tung T Nguyen Journal: J Gen Intern Med Date: 2022-01-06 Impact factor: 6.473
Authors: Anita J Brogan; Sandra E Talbird; James R Thompson; Jeffrey D Miller; Jaime Rubin; Baris Deniz Journal: PLoS One Date: 2014-03-06 Impact factor: 3.240