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Cost Effectiveness of Entecavir versus Lamivudine with Adefovir Salvage in HBeAg-Positive Chronic Hepatitis B

Author

Listed:
  • David Veenstra
  • Sean Sullivan
  • Lauren Clarke
  • Uche Iloeje
  • Eskinder Tafesse
  • Adrian Bisceglie
  • Kris Kowdley
  • Robert Gish

Abstract

Objective: To evaluate the cost effectiveness of treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) with entecavir compared with lamivudine with adefovir salvage, based primarily on the results of a recent 2-year, randomised, multicentre, clinical trial (n=709). Previous economic analyses have been limited by the lack of comparative clinical data for entecavir and lamivudine beyond 1-year duration and for salvage therapy. Methods: We conducted a cost-utility analysis using a Markov model from a USpayer perspective over a lifetime time horizon. The hypothetical cohort was 35-year-old patients with HBeAg-positive CHB. We evaluated 2 years of treatment with entecavir 0.5mg/day versus lamivudine 100mg/day, plus addition of adefovir 10mg/day for patients who developed virologic breakthrough due to resistance to either drug. In a scenario analysis, we considered adefovir plus lamivudine combination therapy for treatment-naive patients. Clinical and economic inputs ($US, year 2006 values) were derived from publicly available data, and probabilistic sensitivity analyses were conducted to evaluate uncertainty in the results. Results: The estimated 10-year cumulative incidence of cirrhosis for patients initiated on entecavir was 2.3% lower than for those on lamivudine (20.5% vs 22.8%). The discounted incremental cost per QALY gained was $US7600 in the base-case analysis, and the 95% central range from probabilistic sensitivity analysis was $US2500–$US19 100. Combination therapy for treatment-naive patients led to an increase in costs without improvement in patient outcomes compared with entecavir monotherapy. Conclusions: Our analysis suggests entecavir improves health outcomes in a cost-effective manner compared with lamivudine with adefovir salvage or combination therapy, and highlights the importance of using evidence-based effectiveness estimates in economic studies of CHB therapies. Copyright Adis Data Information BV 2007

Suggested Citation

  • David Veenstra & Sean Sullivan & Lauren Clarke & Uche Iloeje & Eskinder Tafesse & Adrian Bisceglie & Kris Kowdley & Robert Gish, 2007. "Cost Effectiveness of Entecavir versus Lamivudine with Adefovir Salvage in HBeAg-Positive Chronic Hepatitis B," PharmacoEconomics, Springer, vol. 25(11), pages 963-977, November.
    • Handle: RePEc:spr:pharme:v:25:y:2007:i:11:p:963-977
    DOI: 10.2165/00019053-200725110-00006
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    Cited by:

    1. D. Spackman & David Veenstra, 2008. "A Cost-Effectiveness Analysis of Currently Approved Treatments for HBeAg-Positive Chronic Hepatitis B," PharmacoEconomics, Springer, vol. 26(11), pages 937-949, November.
    2. Hua Zhang & Mingdong Huo & Jianqian Chao & Pei Liu, 2016. "Application of Bayesian Approach to Cost-Effectiveness Analysis of Antiviral Treatments in Chronic Hepatitis B," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-9, August.

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