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