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The cost-effectiveness of long-term antiviral therapy in the management of HBeAg-positive and HBeAg-negative chronic hepatitis B in Singapore Lacey LF; Gane EJ Viral Hepat 2007[Nov]; 14 (11): 751-66The purpose of this study was the economic evaluation of short-duration treatments of chronic hepatitis B (CHB) and longer duration antiviral treatment for up to 5 years. Two 10-health state Markov models were developed for hepatitis B e antigen (HBeAg)-positive and HBeAg-negative CHB patients respectively. The perspective of this economic evaluation was the Singapore healthcare system and CHB patient. The models followed cohorts of HBeAg-positive and HBeAg-negative CHB patients, respectively, over a period of 40 years, by which time the majority of the cohorts would have died if left untreated. Costs and benefits were discounted at 5% per annum. Annual rates of disease progression and the magnitude of treatment effects were obtained from the literature, with a focus on data obtained in Asian patients and meeting the criteria for therapy as described in internationally recognized management guidelines. Short-course therapy with alpha-interferon, or 1-year treatment with pegylated interferon alpha-2a, lamivudine or adefovir had limited impact on disease progression. In contrast, treatment of CHB with antiviral therapy for 5 years substantially decreased the rate of disease progression. Treatment with lamivudine for 1-year is highly cost-effective compared with no treatment of CHB but has limited effect on reducing the rate of disease progression. Compared with 1-year treatment with lamivudine, sequential antiviral therapies for up to 5 years (i.e. lamivudine plus adefovir on emergence of lamivudine resistance or adefovir plus lamivudine on emergence of adefovir resistance) are highly cost-effective by international standards. These conclusions are robust to uncertainties in model inputs and are consistent with the findings of other recently published studies.|Adenine/analogs & derivatives/economics/therapeutic use[MESH]|Antiviral Agents/*economics/*therapeutic use[MESH]|Asian People[MESH]|Cost-Benefit Analysis[MESH]|Drug Costs[MESH]|Female[MESH]|Hepatitis B e Antigens/*blood[MESH]|Hepatitis B virus/*growth & development[MESH]|Hepatitis B, Chronic/*drug therapy/*economics/immunology[MESH]|Humans[MESH]|Interferon alpha-2[MESH]|Interferon-alpha/economics/therapeutic use[MESH]|Lamivudine/economics/therapeutic use[MESH]|Male[MESH]|Markov Chains[MESH]|Models, Economic[MESH]|Organophosphonates/economics/therapeutic use[MESH]|Polyethylene Glycols/economics/therapeutic use[MESH]|Recombinant Proteins[MESH]|Singapore[MESH] |
