Treatment alternatives for hepatitis B cirrhosis: A cost-effectiveness analysis

Fasiha Kanwal, Mary Farid, Paul Martin, Gary Chen, Ian M. Gralnek, Gareth S. Dulai, Brennan M R Spiegel

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

BACKGROUND: Hepatitis B virus (HBV) patients with cirrhosis are at risk for developing costly, morbid, or mortal events, and therefore need highly effective therapies. Lamivudine is effective but is limited by viral resistance. In contrast, adefovir and entecavir have lower viral resistance, but are more expensive. The most cost-effective approach is uncertain. METHODS: We evaluated the cost-effectiveness of six strategies in HBV cirrhosis: (1) No HBV treatment ("do nothing"), (2) lamivudine monotherapy, (3) adefovir monotherapy, (4) lamivudine with crossover to adefovir on resistance ("adefovir salvage"), (5) entecavir monotherapy, or (6) lamivudine with crossover to entecavir on resistance ("entecavir salvage"). The primary outcome was the incremental cost per quality-adjusted life-year (QALY) gained. RESULTS: The "do nothing" strategy was least effective yet least expensive. Compared with "do nothing," using adefovir cost an incremental $19,731. Entecavir was more effective yet more expensive than adefovir, and cost an incremental $25,626 per QALY gained versus adefovir. Selecting between entecavir versus adefovir was highly dependent on the third-party payer's "willingess-to-pay" (e.g., 45% and 60% of patients fall within budget if willing-to-pay $10K and $50K per QALY gained for entecavir, respectively). Both lamivudine monotherapy and the "salvage" strategies were not cost-effective. However, between the two salvage strategies, "adefovir salvage" was more effective and less expensive than "entecavir salvage." CONCLUSION: Both entecavir and adefovir are cost-effective in patients with HBV cirrhosis. Choosing between adefovir and entecavir is highly dependent on available budgets. In patients with HBV cirrhosis with previous lamivudine resistance, "adefovir salvage" appears more effective and less expensive than "entecavir salvage."

Original languageEnglish
Pages (from-to)2076-2089
Number of pages14
JournalAmerican Journal of Gastroenterology
Volume101
Issue number9
DOIs
StatePublished - Sep 1 2006
Externally publishedYes

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Hepatitis B
Cost-Benefit Analysis
Fibrosis
Lamivudine
Hepatitis B virus
Costs and Cost Analysis
Quality-Adjusted Life Years
Therapeutics
Budgets
adefovir
entecavir
Health Insurance Reimbursement

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Treatment alternatives for hepatitis B cirrhosis : A cost-effectiveness analysis. / Kanwal, Fasiha; Farid, Mary; Martin, Paul; Chen, Gary; Gralnek, Ian M.; Dulai, Gareth S.; Spiegel, Brennan M R.

In: American Journal of Gastroenterology, Vol. 101, No. 9, 01.09.2006, p. 2076-2089.

Research output: Contribution to journalArticle

Kanwal, Fasiha ; Farid, Mary ; Martin, Paul ; Chen, Gary ; Gralnek, Ian M. ; Dulai, Gareth S. ; Spiegel, Brennan M R. / Treatment alternatives for hepatitis B cirrhosis : A cost-effectiveness analysis. In: American Journal of Gastroenterology. 2006 ; Vol. 101, No. 9. pp. 2076-2089.
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AU - Farid, Mary

AU - Martin, Paul

AU - Chen, Gary

AU - Gralnek, Ian M.

AU - Dulai, Gareth S.

AU - Spiegel, Brennan M R

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N2 - BACKGROUND: Hepatitis B virus (HBV) patients with cirrhosis are at risk for developing costly, morbid, or mortal events, and therefore need highly effective therapies. Lamivudine is effective but is limited by viral resistance. In contrast, adefovir and entecavir have lower viral resistance, but are more expensive. The most cost-effective approach is uncertain. METHODS: We evaluated the cost-effectiveness of six strategies in HBV cirrhosis: (1) No HBV treatment ("do nothing"), (2) lamivudine monotherapy, (3) adefovir monotherapy, (4) lamivudine with crossover to adefovir on resistance ("adefovir salvage"), (5) entecavir monotherapy, or (6) lamivudine with crossover to entecavir on resistance ("entecavir salvage"). The primary outcome was the incremental cost per quality-adjusted life-year (QALY) gained. RESULTS: The "do nothing" strategy was least effective yet least expensive. Compared with "do nothing," using adefovir cost an incremental $19,731. Entecavir was more effective yet more expensive than adefovir, and cost an incremental $25,626 per QALY gained versus adefovir. Selecting between entecavir versus adefovir was highly dependent on the third-party payer's "willingess-to-pay" (e.g., 45% and 60% of patients fall within budget if willing-to-pay $10K and $50K per QALY gained for entecavir, respectively). Both lamivudine monotherapy and the "salvage" strategies were not cost-effective. However, between the two salvage strategies, "adefovir salvage" was more effective and less expensive than "entecavir salvage." CONCLUSION: Both entecavir and adefovir are cost-effective in patients with HBV cirrhosis. Choosing between adefovir and entecavir is highly dependent on available budgets. In patients with HBV cirrhosis with previous lamivudine resistance, "adefovir salvage" appears more effective and less expensive than "entecavir salvage."

AB - BACKGROUND: Hepatitis B virus (HBV) patients with cirrhosis are at risk for developing costly, morbid, or mortal events, and therefore need highly effective therapies. Lamivudine is effective but is limited by viral resistance. In contrast, adefovir and entecavir have lower viral resistance, but are more expensive. The most cost-effective approach is uncertain. METHODS: We evaluated the cost-effectiveness of six strategies in HBV cirrhosis: (1) No HBV treatment ("do nothing"), (2) lamivudine monotherapy, (3) adefovir monotherapy, (4) lamivudine with crossover to adefovir on resistance ("adefovir salvage"), (5) entecavir monotherapy, or (6) lamivudine with crossover to entecavir on resistance ("entecavir salvage"). The primary outcome was the incremental cost per quality-adjusted life-year (QALY) gained. RESULTS: The "do nothing" strategy was least effective yet least expensive. Compared with "do nothing," using adefovir cost an incremental $19,731. Entecavir was more effective yet more expensive than adefovir, and cost an incremental $25,626 per QALY gained versus adefovir. Selecting between entecavir versus adefovir was highly dependent on the third-party payer's "willingess-to-pay" (e.g., 45% and 60% of patients fall within budget if willing-to-pay $10K and $50K per QALY gained for entecavir, respectively). Both lamivudine monotherapy and the "salvage" strategies were not cost-effective. However, between the two salvage strategies, "adefovir salvage" was more effective and less expensive than "entecavir salvage." CONCLUSION: Both entecavir and adefovir are cost-effective in patients with HBV cirrhosis. Choosing between adefovir and entecavir is highly dependent on available budgets. In patients with HBV cirrhosis with previous lamivudine resistance, "adefovir salvage" appears more effective and less expensive than "entecavir salvage."

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