Cost-Effectiveness of Nucleoside Analog Therapy for Hepatitis B in China:

liver411

A Markov Analysis

<http://www3.interscience.wiley.c ... =1&SRETRY=0>

Value in Health
Early View (Articles online in advance of print)
Published Online: 30 Apr 2010
© 2010 International Society for Pharmacoeconomics and Outcomes Research


Published on behalf of the International Society for Pharmacoeconomics and
Outcomes Research

Cost-Effectiveness of Nucleoside Analog Therapy for Hepatitis B in China: A
Markov Analysis

Bin Wu, MD, PhD, 1 Te Li, MS, 2 Huafeng Chen, MS, 1 Jinfang Shen, MD 1

1 Department of Pharmacy, Renji Hospital, Affiliated to School of Medicine,
Shanghai Jiaotong University, Shanghai, China;   2 Department of Pharmacy,
Yuxi People's Hospital, Yunnan, China

Correspondence to  Jinfang Shen, Department of Pharmacy, Renji Hospital,
Affiliated to School of Medicine, Shanghai Jiaotong University, Dongfang Road
1600, Shanghai, 200233, China. E-mail: [email protected]
Copyright © 2010 International Society for Pharmacoeconomics and Outcomes
Research

ABSTRACT

Objectives: The aim of this study was to investigate the economic consequences
of nucleoside analog therapy for hepatitis B treatment in China.

Methods: A cost-utility analysis of treatments for HBeAg-positive and
HBeAg-negative chronic hepatitis B (CHB) was conducted using a Markov model,
in which patients' yearly transitions between different health states were
tracked. Patients were tracked as they moved between the following health
states: CHB, HBeAg seroconversion (HBeAg-positive CHB patients can have this
special health state), virologic resistance, virologic response, compensated
cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver
transplantation, and death. The transition parameters were derived either from
systematic reviews of the literature or from previous economic studies. Cost
and utility data came from studies based on a Chinese CHB cohort. One-way
sensitivity analyses as well as second-order Monte Carlo and probabilistic
sensitivity analyses were performed.

Results: The entecavir strategy yielded the most quality-adjusted life years
(QALYs) for both HBeAg-positive and HBeAg-negative patients when compared with
the "no treatment," the lamivudine, the adefovir, and the telbivudine
strategies. The risks of complications and mortality also decreased. In the
economic analysis, the "no treatment" strategy was the least effective,
whereas the entecavir strategy was both the least expensive and the most
cost-effective option, followed by telbivudine and lamivudine. The
probabilistic sensitivity analysis showed that the entecavir strategy would
result in improved cost-effectiveness in>90% of cases at a threshold of
$20,000 per QALY. In a one-way sensitivity analysis, the most influential
parameters impacting the model's robustness were the utilities of the CHB and
virologic response health states.

Conclusions: In China, when treating both HBeAg-positive and HBeAg-negative
CHB populations, entecavir is the most cost-effective option when compared
with lamivudine, adefovir, and telbivudine.

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DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1524-4733.2010.00733
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