Feng Tian1, Sherilyn K D Houle1, Mhd Wasem Alsabbagh1, William W L Wong2. 1. School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G1C5, Canada. 2. School of Pharmacy, Faculty of Science, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G1C5, Canada. wwlwong@uwaterloo.ca.
Abstract
BACKGROUND/AIM: Tenofovir alafenamide (TAF) has been approved for treating chronic hepatitis B (CHB) due to a proposed better safety profile in comparison with current therapies. We evaluated the cost effectiveness of TAF and other available treatment options for hepatitis B envelope antigen (HBeAg)-positive and HBeAg-negative CHB patients from a Canadian provincial Ministry of Health perspective. METHODS: A state-transition model based on the published literature was developed to compare treatment strategies involving entecavir (ETV), tenofovir disoproxil fumarate (TDF), and TAF. It adopted a lifetime time horizon. Outcomes measured were predicted number of liver-related deaths, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS: For HBeAg-positive patients, TAF followed by ETV generated an additional 0.16 QALYs/person at an additional cost of Can$14,836.18 with an ICER of Can$94,142.71/QALY compared with TDF followed by ETV. Of the iterations, 28.7% showed that it is the optimal strategy with a Can$50,000 willingness-to-pay threshold. For HBeAg-negative patients, ETV followed by TAF would prevent an additional 13 liver-related deaths per 1000 CHB patients compared with TDF, followed by ETV. It generated an additional 0.13 QALYs/person at an additional cost of Can$59,776.53 with an ICER of Can$461,162.21/QALY compared with TDF, followed by ETV. TAF-containing strategies are unlikely to be a rational choice in either case. The results were sensitive to the HBeAg seroconversion rates and viral suppression rates of the treatments. CONCLUSIONS: Our analysis suggests that TAF is not cost effective at its current cost. A 33.4% reduction in price would be required to make it cost effective for HBeAg-positive patients with a Can$50,000 willingness-to-pay threshold.
BACKGROUND/AIM: Tenofovir alafenamide (TAF) has been approved for treating chronic hepatitis B (CHB) due to a proposed better safety profile in comparison with current therapies. We evaluated the cost effectiveness of TAF and other available treatment options for hepatitis B envelope antigen (HBeAg)-positive and HBeAg-negative CHBpatients from a Canadian provincial Ministry of Health perspective. METHODS: A state-transition model based on the published literature was developed to compare treatment strategies involving entecavir (ETV), tenofovir disoproxil fumarate (TDF), and TAF. It adopted a lifetime time horizon. Outcomes measured were predicted number of liver-related deaths, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS: For HBeAg-positive patients, TAF followed by ETV generated an additional 0.16 QALYs/person at an additional cost of Can$14,836.18 with an ICER of Can$94,142.71/QALY compared with TDF followed by ETV. Of the iterations, 28.7% showed that it is the optimal strategy with a Can$50,000 willingness-to-pay threshold. For HBeAg-negative patients, ETV followed by TAF would prevent an additional 13 liver-related deaths per 1000 CHBpatients compared with TDF, followed by ETV. It generated an additional 0.13 QALYs/person at an additional cost of Can$59,776.53 with an ICER of Can$461,162.21/QALY compared with TDF, followed by ETV. TAF-containing strategies are unlikely to be a rational choice in either case. The results were sensitive to the HBeAg seroconversion rates and viral suppression rates of the treatments. CONCLUSIONS: Our analysis suggests that TAF is not cost effective at its current cost. A 33.4% reduction in price would be required to make it cost effective for HBeAg-positive patients with a Can$50,000 willingness-to-pay threshold.
Authors: Henry L Y Chan; Scott Fung; Wai Kay Seto; Wan-Long Chuang; Chi-Yi Chen; Hyung Joon Kim; Aric Josun Hui; Harry L A Janssen; Abhijit Chowdhury; Tak Yin Owen Tsang; Rajiv Mehta; Edward Gane; John F Flaherty; Benedetta Massetto; Anuj Gaggar; Kathryn M Kitrinos; Lanjia Lin; G Mani Subramanian; John G McHutchison; Young-Suk Lim; Subrat K Acharya; Kosh Agarwal Journal: Lancet Gastroenterol Hepatol Date: 2016-09-22
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: William W L Wong; Petros Pechivanoglou; Josephine Wong; Joanna M Bielecki; Alex Haines; Aysegul Erman; Yasmin Saeed; Arcturus Phoon; Mina Tadrous; Mona Younis; Noha Z Rayad; Valeria Rac; Harry L A Janssen; Murray D Krahn Journal: Syst Rev Date: 2019-08-19
Authors: Eleanor Barnes; Philippa C Matthews; Tingyan Wang; David A Smith; Cori Campbell; Jolynne Mokaya; Oliver Freeman; Hizni Salih; Anna L McNaughton; Sarah Cripps; Kinga A Várnai; Theresa Noble; Kerrie Woods; Jane Collier; Katie Jeffery; Jim Davies Journal: BMC Infect Dis Date: 2021-06-26 Impact factor: 3.090