Cost Effectiveness of Hepatitis B Treatment with Antiviral Agents

Cost is in issue when considering treatment for hepatitis B. Many patients receive initial therapy with lamivudine (Epivir-HBV), in part because this agent is less expensive than the more recently approved adefovir (Hepsera) and entecavir (Baraclude).

However, a study presented at the recent Digestive Disease Week 2006 conference in Los Angeles showed that treatment with entecavir is cost-effective compared with either lamivudine or adefovir. Both HBeAg seroconversion and HBV DNA suppression were markers for treatment success.

This study used a mathematical model to assess the impact of HBV viral load on disease progression. The model included 14 distinct health states, which were used to track clinical outcomes such as HBeAg and HBsAg seroconversion, drug resistance, disease progression, and death. Patients who developed drug resistance were switched to different agents. Estimated risk of cirrhosis based on HBV viral load level was derived from the REVEAL-HBV study, a population-based prospective cohort trial that included 3582 untreated hepatitis B patients.

Results

Assessment of patients who did not experience HBeAg seroconversion but achieved undetectable HBV DNA during therapy (48% with entecavir, 20% with lamivudine, and 9% with adefovir after one year) increased the difference in life expectancy from 0.54 to 0.79 years per patient, compared with seroconversion only. Total healthcare costs decreased from $3574 to $3245, and the incremental cost-effectiveness ratio (ICER) decreased from $10,911 to $7264 per quality-adjusted life-year (QALY). An analysis of two-year entecavir vs adefovir treatment showed an increase in the difference in life expectancy from 0.16 to 0.43 years, and a decrease in the ICER from $10,474 per QALY to $3050 per QALY. In a projected analysis of four-year entecavir vs lamivudine treatment, the difference in life expectancy increased from 0.84 to 1.56 years, and the ICER was $4214 per QALY.

Conclusion

The researchers concluded that entecavir is cost-effective as compared with either lamivudine or adefovir, and that "both seroconversion and complete viral suppression have an important impact on the long-term outcomes of HBV anti-viral therapy."

6/09/06

Reference
DL Veenstra, UH Iloeje, E. Tafesse, and others. Cost-effectiveness of antivirals in HBeAg-positive chronic hepatitis B: impact of seroconversion and viral suppression. Abstract T1848. Digestive Disease Week 2006. May 20-25, 2006. Los Angeles, California.

HBV FDA-approved Drugs  Epivir-HBV (lamivudine; 3TC) Intron A (interferon alfa-2b) Hepsera (adefovir dipivoxil) Baraclude (entecavir) Pegasys (peginterferon alfa-2a)