The cost-effectiveness of treating chronic hepatitis B patients in a median endemic and middle income country.
Özet
Background/aims Chronic hepatitis B (CHB) infection is
a serious public health problem due to its potential liver
disease sequelae and highly expensive medical costs such
as the need for liver transplantation. The aim of this study
was to quantify the burden of active CHB in terms of
mortality and morbidity, the eligibility of antiviral
treatment and to assess various treatment scenarios and
possible salvage combinations for cost-effectiveness.
Methods A population cohort from a large data base of
chronic hepatitis B patients was constructed and stratified
according to 10-year age groups, the prevalence of HBsAg,
HBV DNA level, ALT level, HBeAg status and the presence of cirrhosis. An age-specific Markov model for disease
progression and cost-effectiveness analysis was constructed
and calibrated for the specific population setting.
Results Of about 3.2 million estimated HBsAg carriers,
25 % are eligible for treatment. If the active cohort remains
untreated, 31 % will die due to liver related complications.
Within a 20-year period, 11 % will have developed decompensated cirrhosis, 12 % liver cancer and 6 % will need liver
transplantation. Quality adjusted life years (QALYs) for the
no treatment scenario ranged from 9.3 to 14.0. For scenarios
with antiviral treatment, QALYs ranged from 9.9 to 14.5 for
lamivudine, 13.0–17.5 for salvage therapy, and 16.6–19.0 for
the third generation drugs entecavir and tenofovir.
Conclusion In a country with considerable amount of
active CHB patients, monotherapy with a highly potent
third generation drug has the most health-gain, and is costeffective in both HBeAg-positive and negative in all stages
of liver disease.