Cost effectiveness of entecavir versus lamivudine with adefovir salvage in HBeAg-positive chronic hepatitis B.

Abstract

OBJECTIVE:

To evaluate the cost effectiveness of treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) with entecavir compared with lamivudine with adefovir salvage, based primarily on the results of a recent 2-year, randomised, multicentre, clinical trial (n = 709). Previous economic analyses have been limited by the lack of comparative clinical data for entecavir and lamivudine beyond 1-year duration and for salvage therapy.

METHODS:

We conducted a cost-utility analysis using a Markov model from a US-payer perspective over a lifetime time horizon. The hypothetical cohort was 35-year-old patients with HBeAg-positive CHB. We evaluated 2 years of treatment with entecavir 0.5mg/day versus lamivudine 100mg/day, plus addition of adefovir 10mg/day for patients who developed virologic breakthrough due to resistance to either drug. In a scenario analysis, we considered adefovir plus lamivudine combination therapy for treatment-naive patients. Clinical and economic inputs ($US, year 2006 values) were derived from publicly available data, and probabilistic sensitivity analyses were conducted to evaluate uncertainty in the results.

RESULTS:

The estimated 10-year cumulative incidence of cirrhosis for patients initiated on entecavir was 2.3% lower than for those on lamivudine (20.5% vs 22.8%). The discounted incremental cost per QALY gained was $US7600 in the base-case analysis, and the 95% central range from probabilistic sensitivity analysis was $US2500-$US19 100. Combination therapy for treatment-naive patients led to an increase in costs without improvement in patient outcomes compared with entecavir monotherapy.

CONCLUSIONS:

Our analysis suggests entecavir improves health outcomes in a cost-effective manner compared with lamivudine with adefovir salvage or combination therapy, and highlights the importance of using evidence-based effectiveness estimates in economic studies of CHB therapies.

• Authors: David L Veenstra, Sean D Sullivan, Lauren Clarke, Uche H Iloeje, Eskinder Tafesse, Adrian Di Bisceglie, Kris V Kowdley, Robert G Gish
• Journal: PharmacoEconomics (Pharmacoeconomics) Vol. 25 Issue 11 Pg. 963-77 ( 2007) ISSN: 1170-7690 [Print] New Zealand
• PMID: 17960954 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-HIV Agents
• Antiviral Agents
• Hepatitis B e Antigens
• Organophosphonates
• Lamivudine
• entecavir
• Guanine
• adefovir
• Adenine

Topics

• Adenine (analogs & derivatives, economics, therapeutic use)
• Anti-HIV Agents (economics, therapeutic use)
• Antiviral Agents (economics, therapeutic use)
• Cohort Studies
• Cost-Benefit Analysis
• Disease Progression
• Guanine (analogs & derivatives, economics, therapeutic use)
• Hepatitis B e Antigens (metabolism)
• Hepatitis B, Chronic (drug therapy, economics)
• Humans
• Lamivudine (economics, therapeutic use)
• Markov Chains
• Organophosphonates (economics, therapeutic use)
• Quality of Life
• Salvage Therapy (economics)