Cost-effectiveness analysis of roadmap models in chronic hepatitis B using tenofovir as the rescue therapy
Journal
Antiviral Therapy
Journal Volume
15
Journal Issue
2
Pages
145-155
Date Issued
2010
Author(s)
Lui Y.Y.-N.
Tsoi K.K.-F.
Wong V.W.-S.
Hou J.-L.
Teo E.-K.
Mohamed R.
Piratvisuth T.
Han K.-H.
Mihm U.
Wong G.L.-H.
Chan H.L.-Y.
Abstract
Background: The roadmap approach is recommended to guide chronic hepatitis B treatment. We evaluated the cost-effectiveness of various treatment strategies in the global market. Methods: Lamivudine and telbivudine were tested in roadmap models with switch-to tenofovir if HBV was detectable at week 24 or add-on tenofovir if resistance developed at year 1. Tenofovir and entecavir were tested as continuous monotherapy. In the reference arm, lamivudine was used with add-on tenofovir if resistance developed at year 1. The primary measure of effectiveness was undetectable HBV DNA at year 2. Cost-effectiveness was measured by incremental cost-effectiveness ratio (ICER) in US dollars against the reference arm. Results: In the US and Germany, costs of the reference arms were US $14,486 and US $9,998 for hepatitis B e antigen (HBeAg)-positive and US$11,398 and US$7,531 for HBeAg-negative patients, respectively. In HBeAg- positive patients, the lamivudine roadmap was most costeffective (ICER US $15,260 in the US and US $29,113 in Germany) with comparable effectiveness (75.1%) to other strategies. In HBeAg-negative patients, tenofovir and entecavir monotherapies were most effective (91-96%) and cost-effective (ICER US $31,297-43,387 in the US and US $53,976-59,822 in Germany). In Asia, where telbivudine cost was lower, both telbivudine and lamivudine roadmaps were cost-effective in HBeAg-positive patients. Tenofovir would be most cost-effective in HBeAg-negative patients if its cost equaled that of telbivudine in Asia. Conclusions: In HBeAg-positive patients, lamivudine roadmap was most cost-effective; in Asia, telbivudine roadmap had comparable cost-effectiveness to lamivudine roadmap because of the relatively low price of telblvudine. In HBeAg-negative patients, entecavir and tenofovir monotherapies were more cost-effective than the roadmap models.
SDGs
Other Subjects
entecavir; hepatitis B(e) antigen; lamivudine; peginterferon; telbivudine; tenofovir; virus DNA; add on therapy; article; Asia; comparative study; controlled study; cost effectiveness analysis; Germany; health care cost; hepatitis B; Hepatitis B virus; human; market; model; money; priority journal; United States; Adenine; Antiviral Agents; Asia; Cost-Benefit Analysis; Decision Support Techniques; DNA, Viral; Drug Administration Schedule; Drug Resistance, Viral; Drug Therapy, Combination; Germany; Hepatitis B virus; Hepatitis B, Chronic; Humans; Lamivudine; Models, Economic; Nucleosides; Phosphonic Acids; Pyrimidinones; Salvage Therapy; Treatment Outcome; United States
Type
journal article