BACKGROUND/AIMS: The purpose of this study was to evaluate the cost-effectiveness of 1 year and up to 5 years of antiviral treatment for chronic hepatitis B (CHB). METHODS: Two ten-health-state Markov models were developed for CHB patients. The proportion of patients remaining alive in each health state, and healthcare costs and quality-adjusted life years (QALYs) were determined during annual cycles of these Markov models. The total healthcare costs, life years, and QALYs over the 40-year time horizon of the model were calculated. The perspectives of the cost-effectiveness analysis were the Korean healthcare system and the healthcare needs of the CHB patient. RESULTS: Short-course therapy with alpha-interferon or 1-year treatment with pegylated interferon alpha-2a, lamivudine (LMV), or adefovir (ADV) had limited impact on disease progression. In contrast, either LMV-ADV or ADV-LMV as rescue medication administered for 5 years resulted in a more sustained decrease in the rate of disease progression. The cost-effectiveness threshold in Korea was estimated to be approximately 25,000,000 South Korean won. LMV administered for 1 year is cost-effective in comparison with no treatment for both HBeAg-positive and HBeAg-negative CHB patients, but longer duration antiviral therapies administered for up to 5 years in CHB patients were found to be highly cost-effective by international standards. CONCLUSIONS: Antiviral treatment of CHB with LMV or ADV for up to 5 years using the alternative antiviral agent as rescue medication appears to be a cost-effective strategy for both HBeAg-positive and HBeAg-negative CHB patients in Korea. Economic evaluation of antiviral therapies should be studied further and updated, particularly for newer agents.
Adenine/*analogs & derivatives/economics/therapeutic use ; Antiviral Agents/*economics/therapeutic use ; Cohort Studies ; Cost-Benefit Analysis ; Drug Therapy, Combination ; Hepatitis B e Antigens/blood ; Hepatitis B, Chronic/drug therapy/*economics ; Humans ; Interferon-alpha/*economics/therapeutic use ; Korea ; Lamivudine/*economics/therapeutic use ; Models, Statistical ; Phosphonic Acids/*economics/therapeutic use ; Quality of Life ; Severity of Illness Index

OBJECTIVETo assess the economic evaluation of short- and long-term antiviral treatments of HBeAg-positive chronic hepatitis B from the perspective of the Chinese health care system.

METHODSA 10-health state Markov model was developed to estimate long-term cost and effectiveness of different treatments of HBeAg-positive CHB. Incremental cost-effectiveness analysis was then carried out.

RESULTSIn comparison with no antiviral treatment, lamivudine administered for 1-year was a highly cost-effective short-course treatment for HBeAg-positive CHB. However, of the treatments evaluated, lamivudine plus adefovir as a rescue medication or adefovir plus lamivudine as a rescue medication administered for 5 years resulted in a more sustained decrease in the rate of disease progression. In comparison with 1 year lamivudine treatment, the incremental cost per Quality Adjusted Life Year (QALY) for treatment with lamivudine plus adefovir or adefovir plus lamivudine as a rescue medication for 5 years was CNY 25 115 and 35 577 respectively, which was 55.2% and 36.5% lower than the estimated international threshold value for China.

CONCLUSIONIn comparison with no antiviral treatment, lamivudine administered for 1-year is a highly cost-effective short-course treatment. Longer duration antiviral treatments, lamivudine plus adefovir or adefovir plus lamivudine as a rescue medication are both cost-effective strategies, resulting in a more sustained decrease in the rate of disease progression.

Adenine ; analogs & derivatives ; economics ; therapeutic use ; Antiviral Agents ; economics ; therapeutic use ; Cost-Benefit Analysis ; economics ; Female ; Hepatitis B e Antigens ; blood ; Hepatitis B, Chronic ; blood ; drug therapy ; economics ; Humans ; Lamivudine ; economics ; therapeutic use ; Male ; Organophosphonates ; economics ; therapeutic use ; Quality-Adjusted Life Years ; Treatment Outcome

OBJECTIVETo evaluate their long-term outcome and the efficacy and economic significance of antiviral drugs by investigating the long-term health-related quality of life (HQL) in chronic hepatitis B (CHB) patients.

METHODSThe HQL of 101 CHB patients with biopsy-proven 6 to 18 years ago and 105 persons of general population as control was studied with revised SF-36 questionnaire.

RESULTSThe HQL in CHB patients was lower than that in general population in physical functioning, role physical, general health, mental health, and specific symptoms (mu > or = 2.10, P<0.05).

CONCLUSIONSThe long-term HQL in chronic hepatitis B patients is poor.

Adolescent ; Adult ; Antiviral Agents ; therapeutic use ; Cost of Illness ; Female ; Follow-Up Studies ; Hepatitis B, Chronic ; drug therapy ; economics ; Humans ; Male ; Middle Aged ; Quality of Life ; Surveys and Questionnaires