Introduction of lamivudine for the treatment of ch

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Introduction of lamivudine for the treatment of chronic hepatitis B: Expected clinical and economic outcomes based on 4-year clinical trial data



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Date: Sat, 20 Apr 2002 09:45:45 -0400

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      Journal of Gastroenterology and Hepatology

      Volume 17 Issue 2 Page 153 - February 2002



      CHRONIC HEPATITIS B AND C

      Introduction of lamivudine for the treatment of chronic hepatitis B:

Expected clinical and economic outcomes based on 4-year clinical trial data

      STEVEN CROWLEY*, DAVID TOGNARINI, PAUL DESMOND, MICHAEL LEES AND GAURI

SAAL

      ABSTRACT



      BACKGROUND



      Chronic hepatitis B (CHB) is associated with a significant burden of

illness and treatment involves substantial health-care costs. This study

estimates clinical outcomes and cost-effectiveness of lamivudine compared with other treatment scenarios for CHB, from an Australian health-care provider perspective.



      METHODS



      A two-step modeling approach depicted clinical progression of

hepatitis B in hypothetical patient cohorts using three different treatment scenarios: scenario A, lamivudine and -interferon (IFN-) available; scenario B, IFN- available only; and scenario C, no treatment available. Assumptions were based on clinical trials, published studies, a hepatologists questionnaire and an expert panel follow up. One-year clinical outcomes and costs were estimated using a decision tree, while lifetime costs and outcomes were estimated using available clinical trial data for lamivudine (up to 4 years therapy duration) and a Markov model.



      RESULTS



      The analysis considered only patients with pretreatment elevated

alanine aminotransferase levels  2  upper limit of normal. In the short

term, the introduction of lamivudine is expected to result in almost 3.5

times more CHB patients receiving therapy (lamivudine or IFN-) compared to IFN- only (67 compared to 20, respectively). Hence, scenario A subsequently doubled the seroconver-sion rate. The incremental cost-effectiveness ratio was $A3341 per additional seroconversion. Also, non-seroconverted lamivudine patients are less likely to progress to cirrhosis than those receiving IFN-/no treatment. One-year progression to cirrhosis was estimated at 5.1 with scenario A, compared to 12.2 and 12.7, scenarios B and C, respectively.

From the long-term analysis, lamivudine is expected to increase life

expectancy by years and reduce the lifetime risk of compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma by 6, 12 and 12, respectively. Additionally, the introduction of lamivudine decreases lifetime costs by $548, thus making it a cost-saving and life-extending strategy. In both short- and long-term models, worst case scenarios in sensitivity analyses still associate lamivudine with a favorable cost-effectiveness ratio.



      CONCLUSION



      Introduction of lamivudine is expected to improve health outcomes in CHB patients, resulting in overall savings in health-care costs. In this

model, compared with IFN- only and no treatment, lamivudine allowed more CHB patients to be treated, increased the seroconversion rate, delayed disease progression and prolonged life expectancy.





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