Economic evaluation of treatments for chronic hepatitis B.

Abstract

The aim of this study was to conduct a cost-utility study of adefovir, entecavir, interferon alpha, pegylated interferon alpha, lamivudine and tenofovir for chronic hepatitis B in the context of Brazilian Public Health Care System. A systematic review was carried out for efficacy and safety. Another review was performed to collect utility data and transition probabilities between health states. A Markov model was developed in a time horizon of 40 years with annual cycles for three groups of: HBeAg positive, HBeAg negative, and all patients. These strategies were compared to a fourth group that received no treatment. Discount rates of 5% were applied and sensitivity analyses were performed. Tenofovir offered the best cost-utility ratio for the three evaluated models: U$397, U$385 and U$384 (per QALY, respectively, for HBeAg positive, negative, and all patients). All other strategies were completely dominated because they showed higher costs and lower effectiveness than tenofovir. The sequence of cost-utility in the three models was: tenofovir, entecavir, lamivudine, adefovir, telbivudine, pegylated interferon alpha, and interferon alpha. In the sensitivity analysis, adefovir showed lower cost-utility than telbivudine in some situations. The study has some limitations, primarily related to the creation of scenarios and modeling. In this study, tenofovir presented the best cost-utility ratio. The results obtained in this study will be valuable in decision-making and in the review of the clinical protocol, mainly involving the allocation of available resources for health care.

• Authors: Astrid Wiens, Luana Lenzi, Rafael Venson, Maria Lúcia Alves Pedroso, Cassyano Januário Correr, Roberto Pontarolo
• Journal: The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases (Braz J Infect Dis) 2013 Jul-Aug Vol. 17 Issue 4 Pg. 418-26 ISSN: 1678-4391 [Electronic] Brazil
• PMID: 23849851 (Publication Type: Journal Article, Review, Systematic Review)
• Copyright: Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

Chemical References

• Antiviral Agents
• Hepatitis B e Antigens
• Interferon-alpha
• Organophosphonates
• Recombinant Proteins
• Lamivudine
• Polyethylene Glycols
• entecavir
• Guanine
• adefovir
• Tenofovir
• Adenine
• peginterferon alfa-2a

Topics

• Adenine (analogs & derivatives, economics, therapeutic use)
• Antiviral Agents (economics, therapeutic use)
• Brazil
• Cost-Benefit Analysis
• Drug Therapy, Combination (economics)
• Female
• Guanine (analogs & derivatives, economics, therapeutic use)
• Hepatitis B e Antigens (blood)
• Hepatitis B, Chronic (drug therapy)
• Humans
• Interferon-alpha (economics, therapeutic use)
• Lamivudine (economics, therapeutic use)
• Male
• Markov Chains
• Organophosphonates (economics, therapeutic use)
• Polyethylene Glycols (economics, therapeutic use)
• Recombinant Proteins (economics, therapeutic use)
• Tenofovir