PharmacoEconomics

, Volume 31, Issue 1, pp 63–75 | Cite as

Cost Effectiveness of First-Line Oral Antiviral Therapies for Chronic Hepatitis B

A Systematic Review
  • María Buti
  • Itziar Oyagüez
  • Virginia Lozano
  • Miguel A. Casado
Systematic Review

Abstract

Background

Chronic hepatitis B is a common, progressive disease, particularly when viral replication is detected. Oral antivirals can suppress viral replication and prevent or delay the development of cirrhosis and liver-related complications.

Objective

The aim of this study was to systematically review the quality of cost-effectiveness evidence on first-line treatment with entecavir (ETV) or tenofovir difumarate (TDF) for patients with chronic hepatitis B.

Methods

We searched electronic databases and retrieved articles published up to October 2011, in which the cost effectiveness of ETV or TDF was compared with that of other oral antivirals. The quality of the studies identified was assessed with a standard checklist for critical appraisal.

Results

We selected 16 original papers, all published in the last 5 years. There was a conflict of interest in 12 of the 16 studies due to sponsorship by the corresponding pharmaceutical companies. According to the validity assessment, ten studies were classified as high quality. Five studies performed a cost-effectiveness analysis comparing ETV with TDF; they concluded that TDF dominates ETV. The other 11 studies compared ETV or TDF with other strategies; all concluded that ETV and TDF are both cost-effective interventions.

Conclusions

This systematic review shows that there is valid evidence suggesting that ETV and TDF are cost-effective interventions for the treatment of patients with chronic hepatitis B in many health systems. In countries where both alternatives are available, it appears that TDF dominates ETV. These results could help decision makers and clinicians to understand economic issues regarding the available drugs for first-line treatment of hepatitis B.

Notes

Acknowledgements

The authors thank Candido Gomez and Gema Mora for their collaboration and help in localizing the full-text papers.

Funding This study did not receive any funding. It was carried out independently by the authors.

Conflicts of Interest

MB has participated as a speaker and in advisory boards for Bristol-Myers Squibb (BMS), Gilead Sciences, MSD and Novartis. IO, VL and MAC are members of Pharmacoeconomics & Outcomes Research Iberia (PORIB), a consultancy company that usually works for pharmaceutical enterprises in economic evaluation projects.

Author Contributions

MB conceived the analysis and performed general coordination of the project. IO, MAC and MB designed and defined the search strategy. VL and IO performed the search, reviewed all the references, retrieved the selected publications, and performed a further review of them for data extraction. VL and IO drafted the manuscript. MB and MAC reviewed the draft manuscript and all authors agreed on the final version. MB, who had the idea for the paper, acts as guarantor for the overall content.

Supplementary material

40273_2012_9_MOESM1_ESM.pdf (182 kb)
Supplementary material 1 (PDF 182 kb)

References

  1. 1.
    Ganem D, Prince AM. Hepatitis B virus infection: natural history and clinical consequences. N Engl J Med. 2004;350:1118–29.PubMedCrossRefGoogle Scholar
  2. 2.
    Lok ASF, McMahon BJ. Chronic hepatitis B: AASLD practice guidelines. Hepatology. 2007;45:507–39.PubMedCrossRefGoogle Scholar
  3. 3.
    Hoofnagle JH, Doo E, Liang TJ, et al. Management of hepatitis B: summary of a clinical research workshop. Hepatology. 2007;45:1056–75.PubMedCrossRefGoogle Scholar
  4. 4.
    European Association for the Study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B. J Hepatol. 2009;50:227–42.CrossRefGoogle Scholar
  5. 5.
    Chen CJ, Yang HI, Su J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Mommeja-Marin H, Mondou E, Blum MR, et al. Serum HBV DNA as a marker of efficacy during therapy for chronic HBV infection: analysis and review of the literature. Hepatology. 2003;37:1309–19.PubMedCrossRefGoogle Scholar
  7. 7.
    Liaw YF, Leung N, Kao JH, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int. 2008;3:263–83.CrossRefGoogle Scholar
  8. 8.
    Brown R, Cock E, Colin X, et al. Hepatitis B management costs in France, Italy, Spain and the United Kingdom. J Clin Gastroenterol. 2004;38:S169–74.PubMedCrossRefGoogle Scholar
  9. 9.
    Idris BI, Brosa M, Richardus JH, et al. Estimating the future health burden of chronic hepatitis B and the impact of therapy in Spain. Eur J Gastroenterol Hepatol. 2008;20:320–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Simoens S. How to assess the value of medicines? Front Pharmacol. 2010;1:115.PubMedCrossRefGoogle Scholar
  11. 11.
    García-Altés A, Navas E, Soriano MA. Economic evaluation of public health interventions [in Spanish]. Gac Sanit. 2011;25(Suppl. 1):25–31.PubMedCrossRefGoogle Scholar
  12. 12.
    Ijzerman MJ, Steuten LM. Early assessment of medical technologies to inform product development and market access: a review of methods and applications. Appl Health Econ Health Policy. 2011;9(5):331–47.PubMedCrossRefGoogle Scholar
  13. 13.
    Centre for Reviews and Dissemination. Systematic reviews: CRD’s guidance for undertaking reviews in health care. York: University of York; 2008. http://www.york.ac.uk/inst/crd/pdf/Systematic_Reviews.pdf. Accessed 29 Sept 2011.
  14. 14.
    Drummond MF, Sculpher MJ, Torrance GW, et al. Methods for the economic evaluation of health care programmes. 3rd ed. New York: Oxford University Press; 2005.Google Scholar
  15. 15.
    Arnold E, Yuan Y, Iloeje U, et al. Cost-effectiveness analysis of entecavir versus lamivudine in the first-line treatment of Australian patients with chronic hepatitis B. Appl Health Econ Health Policy. 2008;6(4):231–46.PubMedCrossRefGoogle Scholar
  16. 16.
    Buti M, Brosa M, Casado MA, et al. Modeling the cost-effectiveness of different oral antiviral therapies in patients with chronic hepatitis B. J Hepatol. 2009;51(4):640–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Colombo GL, Gaeta GB, Vigano M, et al. A cost-effectiveness analysis of different therapies in patients with chronic hepatitis B in Italy. Clin Outcomes Res. 2011;3(1):37–46.CrossRefGoogle Scholar
  18. 18.
    Costa AM, L ‘italien G, Nita ME, et al. Cost-effectiveness of entecavir versus lamivudine for the suppression of viral replication in chronic hepatitis B patients in Brazil. Braz J Infect Dis. 2008;12(5):368–73.PubMedGoogle Scholar
  19. 19.
    Dakin H, Bentley A, Dusheiko G. Cost-utility analysis of tenofovir disoproxil fumarate in the treatment of chronic hepatitis B. Value Health. 2010;13(8):922–33.PubMedCrossRefGoogle Scholar
  20. 20.
    Dakin H, Sherman M, Fung S, et al. Cost effectiveness of tenofovir disoproxil fumarate for the treatment of chronic hepatitis B from a Canadian public payer perspective. Pharmacoeconomics. 2011;29(12):1075–91.PubMedCrossRefGoogle Scholar
  21. 21.
    Kanwal F, Farid M, Martin P, et al. Treatment alternatives for hepatitis B cirrhosis: a cost-effectiveness analysis. Am J Gastroenterol. 2006;101(9):2076–89.PubMedCrossRefGoogle Scholar
  22. 22.
    Lui YY, Tsoi KK, Wong VW, et al. Cost-effectiveness analysis of roadmap models in chronic hepatitis B using tenofovir as the rescue therapy. Antivir Ther. 2010;15(2):145–55.PubMedCrossRefGoogle Scholar
  23. 23.
    Orlewska E, Zammit D, Yuan Y, et al. The cost-effectiveness analysis of entecavir in the treatment of chronic hepatitis B (CHB) patients in Poland. Exp Clin Hepatol. 2008;4(3–4):20–8.Google Scholar
  24. 24.
    Schwierz C, Thiry N, Van de Sande S, et al. Economic evaluation of antiviral treatment of chronic hepatitis B in Belgium: part 2 [KCE reports 157B]. Brussels: Belgian Health Care Knowledge Centre (KCE); 2011. http://test.kce.fgov.be/sites/default/files/page_documents/kce_157b_h%C3%A9patite%20b_chronique_tome%202.pdf. Accessed 10 Oct 2011.
  25. 25.
    Spackman DE, Veenstra DL. A cost-effectiveness analysis of currently approved treatments for HBeAg-positive chronic hepatitis B. Pharmacoeconomics. 2008;26(11):937–49.PubMedCrossRefGoogle Scholar
  26. 26.
    Veenstra DL, Sullivan SD, Clarke L, et al. Cost effectiveness of entecavir versus lamivudine with adefovir salvage in HBeAg-positive chronic hepatitis B. Pharmacoeconomics. 2007;25(11):963–77.PubMedCrossRefGoogle Scholar
  27. 27.
    Veenstra DL, Spackman DE, Di Bisceglie A, et al. Evaluating anti-viral drug selection and treatment duration in HBeAg-negative chronic hepatitis B: a cost-effectiveness analysis. Aliment Pharmacol Ther. 2008;27(12):1240–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Wu B, Li T, Chen H, et al. Cost-effectiveness of nucleoside analog therapy for hepatitis B in China: a Markov analysis. Value Health. 2010;13(5):592–600.PubMedCrossRefGoogle Scholar
  29. 29.
    Yuan Y, Iloeje U, Li H, et al. Economic implications of entecavir treatment in suppressing viral replication in chronic hepatitis B (CHB) patients in China from a perspective of the Chinese Social Security program. Value Health. 2008;11(Suppl 1):S11–22.PubMedCrossRefGoogle Scholar
  30. 30.
    Yuan Y, Iloeje UH, Hay J, et al. Evaluation of the cost-effectiveness of entecavir versus lamivudine in hepatitis BeAg-positive chronic hepatitis B patients. J Manag Care Pharm. 2008;14(1):21–33.PubMedGoogle Scholar
  31. 31.
    Levy AR, Kowdley KV, Iloeje U, et al. The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value Health. 2008;11(3):527–38.PubMedCrossRefGoogle Scholar
  32. 32.
    Chang TT, Gish RG, de Man R, et al. A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B. N Engl J Med. 2006;354:1001–10.PubMedCrossRefGoogle Scholar
  33. 33.
    Lai CL, Shouval D, Lok AS, et al. Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B. N Engl J Med. 2006;354:1011–20.PubMedCrossRefGoogle Scholar
  34. 34.
    Chen CJ, Yang HI, Su J, et al. Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65–73.PubMedCrossRefGoogle Scholar
  35. 35.
    Iloeje UH, Yang SI, Su J, et al. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology. 2006;130:678–86.PubMedCrossRefGoogle Scholar
  36. 36.
    Dakin H, Fidler C, Harper C. Mixed treatment comparison meta-analysis evaluating the relative efficacy of nucleos(t)ides for treatment of nucleos(t)ide-naive patients with chronic hepatitis B. Value Health. 2010;13(8):934–45.PubMedCrossRefGoogle Scholar
  37. 37.
    Marcellin P, Heathcote EJ, Buti M, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. N Engl J Med. 2008;359:2442–55.PubMedCrossRefGoogle Scholar
  38. 38.
    Lai CL, Rosmawati M, Lao J, et al. Entecavir is superior to lamivudine in reducing hepatitis B virus DNA in patients with chronic hepatitis B infection. Gastroenterology. 2002;123:1831–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Thomas HC, Manns PM, Gish RG, et al. Decline in serum HBV DNA and ALT normalization is associated with histological response among nucleoside naïve patients in entecavir phase III trials. J Hepatol. 2005;42(Suppl 2):192–3.Google Scholar
  40. 40.
    Fattovich G, Giustina G, Schalm S, et al. Occurrence of hepatocellular carcinoma and decompensation in Western European patients with cirrhosis type B. Hepatology. 1995;21:77–82.PubMedGoogle Scholar
  41. 41.
    Liaw YF, Sung JJ, Chow WC, et al. Lamivudine for patients with chronic hepatitis B and advanced liver disease. N Engl J Med. 2004;351:1521–31.PubMedCrossRefGoogle Scholar
  42. 42.
    Davis GL, Hoofnagle JH. Spontaneous reactivation of chronic hepatitis B virus infection. Gastroenterology. 1984;86:230–5.PubMedGoogle Scholar
  43. 43.
    Chan HLY, Hui AY, Wong ML, et al. Genotype C hepatitis B virus infection is associated with an increased risk of hepatocellular carcinoma. Gut. 2004;53:1494–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Heathcote EJ, Gane EJ, de Man RA, et al. Two year tenofovir disoproxil fumarate (TDF) treatment and adefovir dipivoxil (ADV) switch data in HBeAg-negative patients with chronic hepatitis B (study 102), preliminary analysis [abstract no. 158]. In: 59th Annual Meeting of the American Association for the Study of Liver Diseases. 31 Oct–4 Nov 2008. San Francisco.Google Scholar
  45. 45.
    Marcellin P, Buti M, Krastev Z, et al. Two year tenofovir disoproxil fumarate (TDF) treatment and adefovir dipivoxil (ADV) switch data in HBeAg-negative patients with chronic hepatitis B (study 102) [abstract no. 146]. In: 59th Annual Meeting of the American Association for the Study of Liver Diseases. 31 Oct–4 Nov 2008. San Francisco.Google Scholar
  46. 46.
    Gish RG, Lok AS, Chang TT, et al. Entecavir therapy for up to 96 weeks in patients with HBeAg-positive chronic hepatitis B. Gastroenterology. 2007;133(5):1437–44.PubMedCrossRefGoogle Scholar
  47. 47.
    Yao G, Chen C, Lu W, et al. Efficacy and safety of entecavir compared to lamivudine in nucleoside-naïve patients with chronic hepatitis B: a randomized double-blind trial in China. Hepatol Int. 2007;1(3):365–7.PubMedCrossRefGoogle Scholar
  48. 48.
    Shouval D, Lai CL, Chang TT, et al. Relapse of hepatitis B in HBeAg-negative chronic hepatitis B patients who discontinued successful entecavir treatment: the case for continuous antiviral therapy. J Hepatol. 2009;50(2):289–95.PubMedCrossRefGoogle Scholar
  49. 49.
    Horsmans Y, Thiry N, le Polain M, et al. Cost-effectiveness of antiviral treatment of chronic hepatitis B in Belgium. Part 1: literature review and results of a national study [KCE reports 127C]. Brussels: Belgian Health Care Knowledge Centre (KCE); 2010. https://kce.fgov.be/sites/default/files/page_documents/d20101027324.pdf. Accessed 10 Oct 2011.
  50. 50.
    Iloeje UH, Yang HI, Su J, et al. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology. 2006;130:678–86.PubMedCrossRefGoogle Scholar
  51. 51.
    Chang TT, Gish RG, de Man R, et al. A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B. N Engl J Med. 2006;354:1001–10.PubMedCrossRefGoogle Scholar
  52. 52.
    Gish R, Chang T, De Man RA, et al. Entecavir results in substantial virologic and biochemical improvement and HBeAg seroconversion through 96 weeks of treatment in HBeAg(+) chronic hepatitis B patients (study ETV-022). In: 56th American Association for the Study of Liver Diseases Annual Meeting; 11–15 Nov 2005; San Francisco.Google Scholar
  53. 53.
    Liaw YF, Tai DI, Chu CM, et al. The development of cirrhosis in patients with chronic type B hepatitis: a prospective study. Hepatology. 1988;8:493–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Hsu YS, Chien RN, Yeh CT, et al. Long-term outcome after spontaneous HBeAg seroconversion in patients with chronic hepatitis B. Hepatology. 2002;35:1522–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Fattovich G, Pantalena M, Zagni I, et al. Effect of hepatitis B and C virus infections on the natural history of compensated cirrhosis: a cohort study of 297 patients. Am J Gastroenterol. 2002;97:2886–95.PubMedCrossRefGoogle Scholar
  56. 56.
    Lin YT, Liu YH. Epidemiological study of hepatitis B in 1990–2003 in Wuxi City, Jiangsu Province [in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi. 2004;25(12):1083.PubMedGoogle Scholar
  57. 57.
    Dienstag JL. Hepatitis B virus infection. N Engl J Med. 2008;359:1486–500.PubMedCrossRefGoogle Scholar
  58. 58.
    Liaw YF, Nancy L, Kao JH, et al. Asian-Pacific consensus statement on the management of chronic hepatitis B: a 2008 update. Hepatol Int. 2008;2:263–83.PubMedCrossRefGoogle Scholar
  59. 59.
    Yao G. Entecavir is a potent anti-HBV drug superior to lamivudine: experience from clinical trials in China. J Antimicrob Chemother. 2007;60:201–5.PubMedCrossRefGoogle Scholar
  60. 60.
    Sun X, Qin WX, Li YP, et al. Comparative cost-effectiveness of antiviral therapies in patients with chronic hepatitis B: a systematic review of economic evidence. J Gastroenterol Hepatol. 2007;22(9):1369–77.PubMedCrossRefGoogle Scholar
  61. 61.
    Angus PW. Hepatitis B: weighing the costs of treatment. J Gastroenterol Hepatol. 2002;17(7):737–8.PubMedCrossRefGoogle Scholar
  62. 62.
    Holbrook ML. Cost-effective pharmacologic therapies to treat chronic hepatitis B: how far have we really come? J Manag Care Pharm. 2008;14(1):65–9.PubMedGoogle Scholar
  63. 63.
    Anderson R. Systematic reviews of economic evaluations: utility or futility? Health Econ. 2010;19(3):350–64.PubMedCrossRefGoogle Scholar
  64. 64.
    Carande-Kulis VG, Maciosek MV, Briss PA, et al. Methods for systematic reviews of economic evaluations for the Guide to Community Preventive Services. Task Force on Community Preventive Services. Am J Prev Med. 2000;18(1 Suppl):75–91.PubMedCrossRefGoogle Scholar
  65. 65.
    Jung KT, Shin DW, Lee KJ, et al. Cost-effectiveness of recombinant tissue plasminogen activator in the management of acute ischemic stroke: a systematic review. J Clin Neurol. 2010;6(3):117–26.PubMedCrossRefGoogle Scholar
  66. 66.
    Mauskopf JA, Baker CL, Monz BU, et al. Cost effectiveness of tiotropium for chronic obstructive pulmonary disease: a systematic review of the evidence. J Med Econ. 2010;13(3):403–17.PubMedCrossRefGoogle Scholar
  67. 67.
    Han SH. Natural course, therapeutic options and economic evaluation of therapies for chronic hepatitis B. Drugs. 2006;66(14):1831–51.PubMedCrossRefGoogle Scholar
  68. 68.
    Briggs A. Transportability of comparative effectiveness and cost-effectiveness between countries. Value Health. 2010;13(Suppl. 1):S22–5.PubMedCrossRefGoogle Scholar
  69. 69.
    Vemer P, Rutten-van Mölken MP. Largely ignored: the impact of the threshold value for a QALY on the importance of a transferability factor. Eur J Health Econ. 2011;12(5):397–404.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2012

Authors and Affiliations

  • María Buti
    • 1
    • 2
  • Itziar Oyagüez
    • 3
  • Virginia Lozano
    • 3
  • Miguel A. Casado
    • 3
  1. 1.Servicio de HepatologiaHospital General Universitario Valle de HebronBarcelonaSpain
  2. 2.Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd) del Instituto de Salud Carlos IIIBarcelonaSpain
  3. 3.Pharmacoeconomics & Outcomes Research IberiaMadridSpain

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