Decision analysis model for hepatitis B prophylaxis one year after liver transplantation

Area of Science:

• Hepatology and Transplantation
• Pharmacoeconomics
• Virology

Background:

• Hepatitis B immunoglobulin (HBIG) and lamivudine is the current standard for preventing hepatitis B recurrence post-liver transplant, with recurrence rates between 0-11%.
• Emerging data indicate adefovir's efficacy in managing recurrent hepatitis B infections.
• Hepatitis B recurrence remains a significant concern in liver transplant recipients, necessitating optimized prophylactic strategies.

Purpose of the Study:

• To compare the pharmacoeconomic outcomes of two hepatitis B prophylaxis strategies in liver transplant recipients one year post-transplantation.
• To evaluate the cost-effectiveness of using lamivudine and adefovir as a first-line strategy versus HBIG and lamivudine with later adefovir addition for hepatitis B prophylaxis.

Main Methods:

• A Markov decision analysis model was employed to simulate costs and outcomes over 10 years.
• Strategy 1: Prophylaxis with lamivudine and adefovir.
• Strategy 2: Prophylaxis with intramuscular HBIG and lamivudine, with adefovir added for recurrent cases; subsequent treatment failure managed with tenofovir and entecavir.

Main Results:

• After 10 years, lamivudine and HBIG treatment resulted in a 16.8% hepatitis B recurrence rate.
• Strategy 1 (lamivudine and adefovir) incurred medical costs of $151,819, while Strategy 2 incurred $166,246, yielding a cost saving of $14,427 with Strategy 1.
• Sensitivity analysis indicated the model's highest sensitivity to adefovir and HBIG costs and hepatitis B virus recurrence rates.

Conclusions:

• The lamivudine and adefovir strategy provides significant cost savings compared to the standard HBIG and lamivudine regimen.
• This pharmacoeconomic analysis supports the use of lamivudine and adefovir as a preferred first-line therapy for hepatitis B prophylaxis in liver transplant recipients.
• Optimizing prophylaxis strategies is crucial for improving long-term outcomes and reducing healthcare costs in liver transplantation.