Cost-effectiveness analysis of roadmap models in chronic hepatitis B using tenofovir as the rescue therapy

Yanni Yan Ni Lui, Kelvin Kam Fai Tsoi, Vincent Wai Sun Wong, Jia Horng Kao, Jin Lin Hou, Eng Kiong Teo, Rosmawati Mohamed, Teerha Piratvisuth, Kwang Hyub Han, Ulrike Mihm, Grace Lai Hung Wong, Henry Lik Yuen Chan

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Abstract

Background: The roadmap approach is recommended to guide chronic hepatitis B treatment. We evaluated the cost-effectiveness of various treatment strategies in the global market. Methods: Lamivudine and telbivudine were tested in roadmap models with switch-to tenofovir if HBV was detectable at week 24 or add-on tenofovir if resistance developed at year 1. Tenofovir and entecavir were tested as continuous monotherapy. In the reference arm, lamivudine was used with add-on tenofovir if resistance developed at year 1. The primary measure of effectiveness was undetectable HBV DNA at year 2. Cost-effectiveness was measured by incremental cost-effectiveness ratio (ICER) in US dollars against the reference arm. Results: In the US and Germany, costs of the reference arms were US $14,486 and US $9,998 for hepatitis B e antigen (HBeAg)-positive and US$11,398 and US$7,531 for HBeAg-negative patients, respectively. In HBeAg- positive patients, the lamivudine roadmap was most costeffective (ICER US $15,260 in the US and US $29,113 in Germany) with comparable effectiveness (75.1%) to other strategies. In HBeAg-negative patients, tenofovir and entecavir monotherapies were most effective (91-96%) and cost-effective (ICER US $31,297-43,387 in the US and US $53,976-59,822 in Germany). In Asia, where telbivudine cost was lower, both telbivudine and lamivudine roadmaps were cost-effective in HBeAg-positive patients. Tenofovir would be most cost-effective in HBeAg-negative patients if its cost equaled that of telbivudine in Asia. Conclusions: In HBeAg-positive patients, lamivudine roadmap was most cost-effective; in Asia, telbivudine roadmap had comparable cost-effectiveness to lamivudine roadmap because of the relatively low price of telblvudine. In HBeAg-negative patients, entecavir and tenofovir monotherapies were more cost-effective than the roadmap models.

Original languageEnglish
Pages (from-to)145-155
Number of pages11
JournalAntiviral therapy
Volume15
Issue number2
DOIs
Publication statusPublished - 2010 Apr 16

All Science Journal Classification (ASJC) codes

  • Pharmacology
  • Pharmacology (medical)
  • Infectious Diseases

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    Lui, Y. Y. N., Tsoi, K. K. F., Wong, V. W. S., Kao, J. H., Hou, J. L., Teo, E. K., Mohamed, R., Piratvisuth, T., Han, K. H., Mihm, U., Wong, G. L. H., & Chan, H. L. Y. (2010). Cost-effectiveness analysis of roadmap models in chronic hepatitis B using tenofovir as the rescue therapy. Antiviral therapy, 15(2), 145-155. https://doi.org/10.3851/IMP1496