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A cost-effectiveness analysis of currently approved treatments for HBeAg-positive chronic hepatitis B

D Eldon Spackman1, David L Veenstra

  • 1Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, Washington, USA.

Pharmacoeconomics
|October 15, 2008
PubMed

Insights

Comparing treatments for hepatitis B e antigen-positive chronic hepatitis B (CHB), entecavir and pegylated interferon offer the greatest clinical and economic value. These therapies demonstrate superior cost-effectiveness for managing CHB.

Area of Science:

  • Hepatology
  • Pharmacoeconomics
  • Public Health

Background:

  • Chronic hepatitis B (CHB) affects numerous individuals globally.
  • Several pharmaceuticals are approved for treating hepatitis B e antigen (HBeAg)-positive CHB.
  • The comparative economic value of these treatments remains unclear.

Purpose of the Study:

  • To conduct a cost-utility analysis comparing the economic value of adefovir, entecavir, lamivudine, pegylated interferon, and telbivudine.
  • To evaluate the cost-effectiveness of different treatment initiation strategies for HBeAg-positive CHB from a US payer perspective.

Main Methods:

  • A Markov model-based cost-utility analysis was performed over a lifetime horizon.
  • Data on disease progression, costs, and quality of life were sourced from existing literature.
  • Sensitivity analyses, including probabilistic sensitivity analysis, were utilized to assess result uncertainty.

Main Results:

  • Entecavir and pegylated interferon demonstrated the largest treatment benefits in terms of quality-adjusted life-years (QALYs).
  • At a threshold of $50,000 per QALY, entecavir had a 57% probability of being cost-effective, followed by pegylated interferon (37%).
  • Treatment initiation strategies significantly impacted outcomes, with results sensitive to baseline seroconversion rates and viral suppression effects on cirrhosis risk.

Conclusions:

  • Initiating treatment for HBeAg-positive CHB with entecavir or pegylated interferon offers significant clinical and economic advantages.
  • Favorable combinations of seroconversion, viral suppression, and resistance profiles are key to maximizing treatment value.
  • These findings support informed decision-making for managing HBeAg-positive CHB.
Abstract

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