Artikel ; Online: Cost-Effectiveness Analysis of Alternative Antiviral Strategies for the Treatment of HBeAg-Positive and HBeAg-Negative Chronic Hepatitis B in the United Kingdom.
2015 Band 18, Heft 6, Seite(n) 800–809
Abstract: Background: Seven drugs are licensed for the treatment of chronic hepatitis B (CHB) in the United Kingdom. Which initial treatment, secondary therapy, and whether antivirals should be given alone or in combination are questions of considerable ... ...
| Abstract | Background: Seven drugs are licensed for the treatment of chronic hepatitis B (CHB) in the United Kingdom. Which initial treatment, secondary therapy, and whether antivirals should be given alone or in combination are questions of considerable uncertainty. Objective: The aim of this model was to undertake a comprehensive economic evaluation of all antiviral treatments for CHB to recommend the most cost-effective therapeutic sequence. Methods: We developed a probabilistic Markov model to compare the cost-effectiveness of all clinically relevant antiviral treatment sequences for nucleos(t)ide-naive adults with hepatitis B e-antigen (HBeAg)-positive or HBeAg-negative CHB. Relative rates of HBeAg seroconversion and viral suppression were obtained from a network meta-analysis. Data on mortality, antiviral drug resistance, durability of response, adverse events, and costs were obtained from published literature. Results are reported in terms of lifetime costs, quality-adjusted life-years (QALYs), and expected net benefit. Results: In the base-case analysis, pegylated interferon alpha-2a (peg-IFN α-2a) followed by tenofovir disoproxil fumarate was most effective and cost-effective in HBeAg-positive patients, with a cost of £7488 per QALY gained compared with no treatment. In HBeAg-negative patients, peg-IFN α-2a followed by entecavir was most effective and cost-effective, with a cost of £6981 per QALY gained. The model was robust to a wide range of sensitivity analyses. Conclusions: Peg-IFN α-2a followed by tenofovir disoproxil fumarate or entecavir is the most effective antiviral treatment strategy for people with both variants of CHB. At a cost of less than £10,000 per QALY gained, these sequences are considered cost-effective in England and Wales. The results of this analysis were used to inform 2013 National Institute for Health and Care Excellence guideline recommendations. |
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| Mesh-Begriff(e) | Adult ; Antiviral Agents/economics ; Antiviral Agents/therapeutic use ; Biomarkers/blood ; Comparative Effectiveness Research ; Cost-Benefit Analysis ; Decision Support Techniques ; Drug Costs ; Drug Substitution/economics ; Drug Therapy, Combination/economics ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/blood ; Hepatitis B, Chronic/diagnosis ; Hepatitis B, Chronic/drug therapy ; Hepatitis B, Chronic/economics ; Humans ; Male ; Markov Chains ; Models, Economic ; Patient Selection ; Practice Guidelines as Topic ; Probability ; Quality of Life ; Quality-Adjusted Life Years ; State Medicine/economics ; Time Factors ; Treatment Outcome ; United Kingdom ; Young Adult |
| Chemische Substanzen | Antiviral Agents ; Biomarkers ; Hepatitis B e Antigens |
| Sprache | Englisch |
| Erscheinungsdatum | 2015-09 |
| Erscheinungsland | United States |
| Dokumenttyp | Comparative Study ; Journal Article ; Meta-Analysis |
| ZDB-ID | 1471745-1 |
| ISSN | 1524-4733 ; 1098-3015 |
| ISSN (online) | 1524-4733 |
| ISSN | 1098-3015 |
| DOI | 10.1016/j.jval.2015.05.007 |
| Datenquelle | MEDical Literature Analysis and Retrieval System OnLINE |
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