Should chronic hepatitis B be treated as early as possible?

Area of Science:

• Hepatology
• Pharmacoeconomics
• Virology

Background:

• Chronic hepatitis B (CHB) infection affects millions globally.
• Current treatments include tenofovir and entecavir, with varying cost-effectiveness.
• Understanding long-term outcomes and optimal treatment strategies is crucial.

Purpose of the Study:

• To evaluate the cost-effectiveness of tenofovir versus entecavir for CHB treatment.
• To assess treatment impact across different patient subgroups (e antigen positive/negative, cirrhosis status).
• To inform clinical guidelines on targeted antiviral therapy.

Main Methods:

• Multicenter survey of 544 CHB patients assessing quality of life and costs.
• Natural disease progression analysis in 278 patients.
• Markov modeling to simulate long-term outcomes for hypothetical patient cohorts.

Main Results:

• Tenofovir demonstrates cost-effectiveness over entecavir due to lower price in Belgium.
• Treatment cost-effectiveness is significantly higher for cirrhotic patients (€29,000/QALY) compared to non-cirrhotic patients (€110,000-€131,000/QALY).
• Quality of life did not improve with viral load reduction; transition to cirrhosis is age-dependent.

Conclusions:

• Long-term trial data for tenofovir/entecavir with hard endpoints are limited.
• The impact of these treatments on hepatocellular carcinoma (HCC) remains uncertain.
• Antiviral therapy should prioritize patients with cirrhosis or those at high risk of progression.