The cost-effectiveness of treating chronic hepatitis B patients in a median endemic and middle income country.

Chronic hepatitis B (CHB) infection is a serious public health problem due to its potential liver disease sequelae and highly expensive medical costs such as the need for liver transplantation. The aim of this study was to quantify the burden of active CHB in terms of mortality and morbidity, the eligibility of antiviral treatment and to assess various treatment scenarios and possible salvage combinations for cost-effectiveness.
A population cohort from a large data base of chronic hepatitis B patients was constructed and stratified according to 10-year age groups, the prevalence of HBsAg, HBV DNA level, ALT level, HBeAg status and the presence of cirrhosis. An age-specific Markov model for disease progression and cost-effectiveness analysis was constructed and calibrated for the specific population setting.
Of about 3.2 million estimated HBsAg carriers, 25% are eligible for treatment. If the active cohort remains untreated, 31% will die due to liver related complications. Within a 20-year period, 11% will have developed decompensated cirrhosis, 12% liver cancer and 6% will need liver transplantation. Quality adjusted life years (QALYs) for the no treatment scenario ranged from 9.3 to 14.0. For scenarios with antiviral treatment, QALYs ranged from 9.9 to 14.5 for lamivudine, 13.0-17.5 for salvage therapy, and 16.6-19.0 for the third generation drugs entecavir and tenofovir.
In a country with considerable amount of active CHB patients, monotherapy with a highly potent third generation drug has the most health-gain, and is cost-effective in both HBeAg-positive and negative in all stages of liver disease.
AuthorsMehlika Toy, Fatih Oguz Onder, Ramazan Idilman, Gokhan Kabacam, Jan Hendrik Richardus, Mithat Bozdayi, Meral Akdogan, Zarife Kuloglu, Aydan Kansu, Solko Schalm, Cihan Yurdaydin
JournalThe European journal of health economics : HEPAC : health economics in prevention and care (Eur J Health Econ) Vol. 13 Issue 5 Pg. 663-76 (Oct 2012) ISSN: 1618-7601 [Electronic] Germany
PMID22815098 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Antiviral Agents
  • Adolescent
  • Adult
  • Aged
  • Antiviral Agents (economics, therapeutic use)
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cost-Benefit Analysis
  • Disease Progression
  • Female
  • Hepatitis B, Chronic (drug therapy, economics, epidemiology)
  • Humans
  • Income (statistics & numerical data)
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Prevalence
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • Turkey (epidemiology)
  • Young Adult

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