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Cost-Effectiveness Comparison Between the Response-Guided Therapies and Monotherapies of Nucleos(t)ide Analogues for Chronic Hepatitis B Patients in China

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Abstract

Background and Objective

Nucleos(t)ide analogue (NA) monotherapies are typically used as the primary treatment for chronic hepatitis B (CHB) patients, including lamivudine (LAM), telbivudine (TBV), adefovir (ADV), entecavir (ETV) and tenofovir (TDF). For high-resistance NAs (LAM, TBV, ADV), they can generate excellent clinical outcomes by using response-guided therapy; however, their pharmacoeconomic profiles remain unclear in China. We aimed to evaluate the cost effectiveness between response-guided therapies and monotherapies of NAs for Chinese hepatitis B e-antigen (HBeAg)-positive and -negative CHB patients.

Methods

We constructed a Markov model to simulate CHB progression associated with 12 treatment strategies using effectiveness and cost data from the published literature. We measured the lifetime costs, quality adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs). One-way sensitivity (especially to extend the range of the TDF price) and probabilistic sensitivity analyses were used to explore the uncertainties of the model.

Results

For both HBeAg-positive and -negative patients, no treatment strategy generated the lowest lifetime costs (US$31,185–US$31,338) and QALYs (7.54–7.58). ETV and TDF monotherapies were not dominated by other treatments, whereas, the ICER of ETV monotherapy was the lowest (US$6112/QALY–US$8533/QALY). For each high-resistance NA, compared with its monotherapy, the ICERs of its response-guided therapies were below the willingness-to-pay threshold of US$22,833/QALY. Additionally, TDF monotherapy was the preferred treatment when its price dropped to US$1820/year or lower.

Conclusion

Among 12 treatment strategies evaluated, ETV monotherapy is the most cost-effective treatment for treatment-naive CHB patients in China. The response-guided therapies of high-resistance NAs are more cost-effective than their monotherapies.

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    Authors and Affiliations

    1. Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283, Jianghai Avenue, Haizhu District, Guangzhou, 510310, Guangdong Province, China

      Keng Lai, Chi Zhang, Weixia Ke, Yanhui Gao, Shudong Zhou, Li Liu & Yi Yang

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    1. Keng Lai
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    The National Natural Science Foundation of China (Grant No. 71573059) provided financial support for this work. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the article.

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    K. Lai and C. Zhang contributed equally to this work.

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    Lai, K., Zhang, C., Ke, W. et al. Cost-Effectiveness Comparison Between the Response-Guided Therapies and Monotherapies of Nucleos(t)ide Analogues for Chronic Hepatitis B Patients in China. Clin Drug Investig 37, 233–247 (2017). https://doi.org/10.1007/s40261-016-0486-8

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