Should chronic hepatitis B be treated as early as possible?

Abstract

OBJECTIVES:

We studied the cost-effectiveness of tenofovir and entecavir in e antigen positive (CHBe+) and negative (CHBe-) chronic hepatitis B.

METHODS:

Using a multicenter survey including 544 patients we measured patient quality of life and attributable costs by clinical disease stage. Natural disease progression was studied in 278 patients in a single center. A Markov model was constructed to follow hypothetical cohorts of treated and untreated 40-year-old CHBe+ and CHBe- patients and 50-year-old patients with compensated cirrhosis.

RESULTS:

We did not find an improvement in quality of life when viral load was reduced under treatment. Transition rates to liver cirrhosis were found to be age-dependent. Assuming equal effectiveness, tenofovir dominates the entecavir strategy because of its lower price in Belgium. The incremental cost-effectiveness ratio (ICER) of tenofovir after 20 years is more favorable for treating Caucasian cirrhotic patients (mean ICER €29,000/quality-adjusted life-year [QALY]) compared with treating non-cirrhotic patients (mean ICER €110,000 and 131,000/QALY for CHB e+ and e-, respectively). Within the non-cirrhotic patients the ICER decreases with increasing cohort starting age from 30 to 50 years.

CONCLUSIONS:

Results of long-term models for tenofovir or entecavir treatment of CHB need to be interpreted with caution as long-term trials with hard end points are lacking. Especially the effect on HCC remains highly uncertain. Based on cost-effectiveness considerations such antiviral treatment should be targeted at patients with cirrhosis or at risk of rapid progression to this disease stage.

• Authors: Frank Hulstaert, Christoph Schwierz, Frederik Nevens, Nancy Thiry, Mohamed Gamil, Isabelle Colle, Stefaan Van de Sande, Yves Horsmans
• Journal: International journal of technology assessment in health care (Int J Technol Assess Health Care) Vol. 29 Issue 1 Pg. 35-41 (Jan 2013) ISSN: 1471-6348 [Electronic] England
• PMID: 23298548 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antiviral Agents
• Hepatitis B e Antigens
• Organophosphonates
• entecavir
• Guanine
• Tenofovir
• Adenine

Topics

• Adenine (analogs & derivatives, economics, therapeutic use)
• Adult
• Antiviral Agents (economics, therapeutic use)
• Belgium
• Cost-Benefit Analysis
• Early Diagnosis
• Guanine (analogs & derivatives, economics, therapeutic use)
• Health Care Surveys
• Hepatitis B e Antigens (blood)
• Hepatitis B, Chronic (drug therapy, virology)
• Humans
• Liver Cirrhosis (etiology)
• Markov Chains
• Middle Aged
• Organophosphonates (economics, therapeutic use)
• Quality of Life
• Secondary Prevention
• Tenofovir
• Treatment Outcome
• Viral Load (drug effects)