Skip to main content

Advertisement

SpringerLink
Log in

Economic Evaluation of Oral Nucleos(t)ide Analogues for Patients with Chronic Hepatitis B in Thailand

  • Original Research Article
  • Published:
Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Background

Nucleos(t)ide analogues (NAs) are the main drug category used in the treatment of chronic hepatitis B (CHB). There is a need to update the economic evaluation of CHB treatment.

Objective

This study aimed to determine the cost effectiveness of NAs for CHB in Thailand.

Method

We used a lifetime Markov model undertaken from a societal perspective. Tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF), entecavir (ETV) with TDF or TAF as rescue medications, and lamivudine (LAM) with TDF or TAF rescue medications were compared with best supportive care (BSC). We performed a network meta-analysis to estimate the treatment effects of each NA on hepatitis B surface antigen (HBsAg) loss in an Asian population and performed an additional literature review to identify inputs. We calculated incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-years (QALYs) and performed sensitivity analyses.

Results

Compared with BSC, all NAs could improve patients’ QALYs, with results ranging from 4.04 to 4.25 QALYs gained. TAF, TDF, LAM/TAF, and LAM/TDF yielded lower total lifetime costs than BSC, ranging from − $US1387 to − 814, whereas ETV/TAF and ETV/TDF yielded higher total lifetime costs than BSC, ranging from $US4965 to 4971. The ICER was $US1230/QALY for ETV/TDF and $US1228/QALY for ETV/TAF. Full incremental analysis showed that the ICER for LAM/TAF was $US1720/QALY compared with TAF.

Conclusion

At current prices, TAF, TDF, LAM/TAF, and LAM/TDF are dominant options, and ETV/TAF or ETV/TDF are cost-effective options. LAM/TAF is the most cost-effective option, followed by TAF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546–55.

    Article  Google Scholar 

  2. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370–98.

  3. Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: new estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine. 2012;30(12):2212–9.

    Article  CAS  Google Scholar 

  4. Leroi C, Adam P, Khamduang W, Kawilapat S, Ngo-Giang-Huong N, Ongwandee S, et al. Prevalence of chronic hepatitis B virus infection in Thailand: a systematic review and meta-analysis. Int J Infect Dis. 2016;51:36–43.

    Article  Google Scholar 

  5. McMahon BJ. The natural history of chronic hepatitis B virus infection. Semin Liver Dis. 2004;24(Suppl 1):17–21.

    Article  Google Scholar 

  6. Hoofnagle JH, Doo E, Liang TJ, Fleischer R, Lok AS. Management of hepatitis B: summary of a clinical research workshop. Hepatology. 2007;45(4):1056–75.

    Article  CAS  Google Scholar 

  7. Lok AS, McMahon BJ. Chronic hepatitis B. Hepatology. 2007;45(2):507–39.

    Article  CAS  Google Scholar 

  8. Ganem D, Prince AM. Hepatitis B virus infection–natural history and clinical consequences. N Engl J Med. 2004;350(11):1118–29.

    Article  CAS  Google Scholar 

  9. Fattovich G. Natural history and prognosis of hepatitis B. Semin Liver Dis. 2003;23(1):47–58.

    Article  Google Scholar 

  10. World Health Organization. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. In: Lesi O, McMahon B, Siegfried N, editors. France: WHO Press; 2015.

  11. Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004;127(5 Suppl 1):S35-50.

    Article  Google Scholar 

  12. Hadziyannis SJ, Papatheodoridis GV. Hepatitis B e antigen-negative chronic hepatitis B: natural history and treatment. Semin Liver Dis. 2006;26(2):130–41.

    Article  CAS  Google Scholar 

  13. Coffin CS, Fung SK. Management of Hepatitis B Virus Infection: 2018 Guidelines from the Canadian Association for the Study of the Liver and Association of Medical Microbiology and Infectious Disease Canada. Can Liver J. 2018;1(4):156–217.

    Article  Google Scholar 

  14. Thai Association for the Study of the Liver. Thailand practice guideline for management of chronic hepatitis B and C. Nonthaburi: Parbpin Co, Ltd.; 2015.

    Google Scholar 

  15. Wong WWL, Pechivanoglou P, Wong J, Bielecki JM, Haines A, Erman A, et al. Antiviral treatment for treatment-naive chronic hepatitis B: systematic review and network meta-analysis of randomized controlled trials. Syst Rev. 2019;8(1):207.

    Article  Google Scholar 

  16. Chan HL, Fung S, Seto WK, Chuang WL, Chen CY, Kim HJ, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of HBeAg-positive chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol. 2016;1(3):185–95.

    Article  Google Scholar 

  17. Buti M, Gane E, Seto WK, Chan HL, Chuang WL, Stepanova T, et al. Tenofovir alafenamide versus tenofovir disoproxil fumarate for the treatment of patients with HBeAg-negative chronic hepatitis B virus infection: a randomised, double-blind, phase 3, non-inferiority trial. Lancet Gastroenterol Hepatol. 2016;1(3):196–206.

    Article  Google Scholar 

  18. Tian F, Houle SKD, Alsabbagh MW, Wong WWL. Cost-effectiveness of tenofovir alafenamide for treatment of chronic hepatitis B in Canada. Pharmacoeconomics. 2020;38(2):181–92.

    Article  Google Scholar 

  19. Tantai N, Chaikledkaew U, Tanwandee T, Werayingyong P, Teerawattananon Y. A cost-utility analysis of drug treatments in patients with HBeAg-positive chronic hepatitis B in Thailand. BMC Health Serv Res. 2014;14(14):170.

    Article  Google Scholar 

  20. Chaikledkaew U, Teerawattananon Y, Kongphitayachai S, Suksomboon N. Guidelines for health technology assessment in Thailand. 1st ed. Nonthaburi: The graphico system; 2009.

  21. Chaikledkaew U, Teerawattananon Y. Guidelines for health technology assessment in Thailand. 2nd ed. Nonthaburi: Wacharin; 2013.

  22. Drug and Medical Supply Information Center: Ministry of Public Health. Median price for medications. 2021 [cited 2021 10 May]. http://dmsic.moph.go.th/.

  23. Health Intervention and Technology Assessment: Ministry of Public Health. Standard cost list for health technology assessment. 2009 [cited 2021 15 May]. https://costingmenu.hitap.net/.

  24. Bureau of Trade and Economic Indicies; Ministry of Commerce. Consumer Price Index. 2020 [cited 2021 15 May]. http://www.price.moc.go.th/price/cpi/index_new_all.asp.

  25. Exchange Rates UK. Thai Baht to US Dollar Spot Exchange Rates for 2019. 2021 [cited 2021 12 April]. https://www.exchangerates.org.uk/THB-USD-spot-exchange-rates-history-2019.html.

  26. Permsuwan U, Guntawongwan K, Buddhawongsa P. Handling time in economic evaluation studies. J Med Assoc Thai. 2014;97(Suppl 5):S50–8.

    PubMed  Google Scholar 

  27. Thavorncharoensap M, Teerawattananon Y, Natanant S, Kulpeng W, Yothasamut J, Werayingyong P. Estimating the willingness to pay for a quality-adjusted life year in Thailand: does the context of health gain matter? Clinicoecon Outcomes Res. 2013;5:29–36.

    Article  Google Scholar 

  28. Dienstag JL. Benefits and risks of nucleoside analog therapy for hepatitis B. Hepatology. 2009;49(5 Suppl):S112–21.

    Article  CAS  Google Scholar 

  29. Geng J, Bao H, Chen Y, Shi L, Geng J, Wang Q, et al. Nucleos(t)ide analogues for the treatment of chronic hepatitis B: a systematic review with network meta-analysis. Expert Rev Anti Infect Ther. 2020;18(8):823–34.

    Article  CAS  Google Scholar 

  30. Sbarigia U, Vincken T, Wigfield P, Hashim M, Heeg B, Postma M. A comparative network meta-analysis of standard of care treatments in treatment-naive chronic hepatitis B patients. J Comp Eff Res. 2020;9(15):1051–65.

    Article  Google Scholar 

  31. Thongsawat S, Piratvisuth T, Pramoolsinsap C, Chutaputti A, Tanwandee T, Thongsuk D. Resource utilization and direct medical costs of chronic hepatitis C in Thailand: a heavy but manageable economic burden. Value Health Reg Issues. 2014;3:12–8.

    Article  Google Scholar 

  32. Chongmelaxme B, Phisalprapa P, Sawangjit R, Dilokthornsakul P, Chaiyakunapruk N. Weight reduction and pioglitazone are cost-effective for the treatment of non-alcoholic fatty liver disease in Thailand. Pharmacoeconomics. 2019;37(2):267–78.

    Article  Google Scholar 

  33. de Fraga RS, Van Vaisberg V, Mendes LCA, Carrilho FJ, Ono SK. Adverse events of nucleos(t)ide analogues for chronic hepatitis B: a systematic review. J Gastroenterol. 2020;55(5):496–514.

    Article  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University.

Author information

Authors and Affiliations

  1. Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Mueang Phitsanulok, Thailand

    Piyameth Dilokthornsakul

  2. Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand

    Pajaree Sriuttha & Unchalee Permsuwan

  3. Clinical Trial and Evidence-Based Synthesis Research Cluster , Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand

    Ratree Sawangjit

  4. Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Pisit Tangkijvanich

  5. Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Maneerat Chayanupatkul

  6. Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Tawesak Tanwandee

  7. Liver Disease Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Wattana Sukeepaisarnjaroen

Authors
  1. Piyameth Dilokthornsakul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ratree Sawangjit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pisit Tangkijvanich
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maneerat Chayanupatkul
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tawesak Tanwandee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wattana Sukeepaisarnjaroen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Pajaree Sriuttha
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Unchalee Permsuwan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Piyameth Dilokthornsakul.

Ethics declarations

Conflict of interest

Piyameth Dilokthornsakul, Ratree Sawangjit, Pisit Tangkijvanich, Maneerat Chayanupatkul, Tawesak Tanwandee,Wattana Sukeepaisarnjaroen, Pajaree Sriuttha, Unchalee Permsuwan have no conflicts of interest that are directly relevant to the content of this article.

Funding

This study was funded by the Thai Association of the Study of the Liver and the Thailand Research Fund (TRF) Senior Research Scholar (RTA6280004). The funders had no role in any process in the conduct of this study.

Ethics approval

Not applicable

Consent to participate

Not applicable

Consent for publication

Not applicable

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Models used in the current study are available from the corresponding author on reasonable request.

Author contributions

Piyameth Dilokthornsakul, Maneerat Chayanupatkul, and Unchalee Permsuwan: study design, data collection, data analysis, manuscript preparation. Ratree Sawangjit: study design, data collection, manuscript preparation. Pisit Tangkijvanich and Tawesak Tanwandee: study design, data analysis, manuscript preparation. Wattana Sukeepaisarnjaroen and Pajaree Sriuttha: study design, data collection. All authors provided final approval of the manuscript.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 9819 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dilokthornsakul, P., Sawangjit, R., Tangkijvanich, P. et al. Economic Evaluation of Oral Nucleos(t)ide Analogues for Patients with Chronic Hepatitis B in Thailand. Appl Health Econ Health Policy 20, 587–596 (2022). https://doi.org/10.1007/s40258-022-00719-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40258-022-00719-y

Search

Navigation