First line nucleos(t)ide analog monotherapy is more cost-effective than combination strategies in hepatitis B e antigen-positive chronic hepatitis B patients in China
10.1097/CM9.0000000000000445
- Author:
Xue-Ru YIN
1
;
Zhi-Hong LIU
1
;
Jing LIU
2
;
Yuan-Yuan LIU
1
;
Li XIE
3
;
Li-Bo TAO
2
;
Ji-Dong JIA
4
;
Fu-Qiang CUI
5
;
Gui-Hua ZHUANG
6
;
Jin-Lin HOU
1
Author Information
1. Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
2. Health Economics Research Institute, Sun Yat-Sen University, Guangzhou, Guangdong 510085, China
3. Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiao Tong University Health Science Center, Xi’an, Shaanxi 710061, China
4. Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
5. School of Public Health, Peking University, Beijing 100191, China
6. School of Public Health, Xi’an Jiao Tong University Health Science Center, Xi’an, Shaanxi 710061, China
- Publication Type:Journal Article
- Keywords:
Hepatitis B;
Functional cure;
Quality-adjusted life-year;
Cost-effectiveness
- From:
Chinese Medical Journal
2019;132(19):2315-2324
- CountryChina
- Language:English
-
Abstract:
Background:Nucleos(t)ide analog (NA) in combination with peginterferon (PegIFN) therapy in patients with hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) shows better effectiveness than NA monotherapy in hepatitis B surface antigen loss, termed "functional cure," based on previous published studies. However, it is not known which strategy is more cost-effective on functional cure. The aim of this study was to analyze the cost-effectiveness of first-line monotherapies and combination strategies in HBeAg-positive CHB patients in China from a social perspective.
Methods:A Markov model was developed with functional cure and other five states including CHB, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and death to assess the cost-effectiveness of seven representative treatment strategies. Entecavir (ETV) monotherapy and tenofovir disoproxil fumarate (TDF) monotherapy served as comparators, respectively.
Results:In the two base-case analysis, compared with ETV, ETV generated the highest costs with $44,210 and the highest quality-adjusted life-years (QALYs) with 16.78 years. Compared with TDF, treating CHB patients with ETV and NA - PegIFN strategies increased costs by $7639 and $6129, respectively, gaining incremental QALYs by 2.20 years and 1.66 years, respectively. The incremental cost-effectiveness ratios were $3472/QALY and $3692/QALY, respectively, which were less than one-time gross domestic product per capita. One-way sensitivity analysis and probabilistic sensitivity analyses showed the robustness of the results.
Conclusion:Among seven treatment strategies, first-line NA monotherapy may be more cost-effective than combination strategies in HBeAg-positive CHB patients in China.
