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Cost-Effectiveness Analysis of Lamivudine for the Treatment of Chronic Hepatitis B

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Abstract

Objective: To estimate the short term and long term cost effectiveness, from a healthcare perspective, associatedwith the introduction of lamivudine for chronic hepatitis B.

Design:The analysis used a 2-step modelling approach. A decision tree was used to estimate clinical outcomes and costs after 1 year. The 1-year results were then extrapolated to 70 years using a Markov model.

Patients: The study population comprised hypothetical cohorts of patients with chronic hepatitis B, representative of those likely to receive treatment in clinical practice in Australia.

Main outcome measures and results: In the short term, more patients seroconvertedwhen lamivudinewas available, with an incremental cost-effectiveness ratio of 3341 Australian dollars ($A) per additional seroconversion. In the long term, the introduction of lamivudine increased life expectancy by 3.9 years [3.2 quality-adjusted life-years (QALYs)] compared with when interferon-α was the only treatment, or 4.6 years (3.8 QALYs) comparedwith no treatment. There were reductions in lifetime risk of developing compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma of 5, 11 and 11%, respectively, when lamivudine was available. The incremental cost of having lamivudine available, as opposed to interferon-α only, was $A633 per year of life saved or $A735 per QALY.

Conclusion: The introduction of lamivudine is expected to reduce and delay the progression of chronic hepatitis B, increasing the life expectancy and quality of life of patients for a small overall increase in healthcare costs.

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Acknowledgements

This study was funded by GlaxoWellcome Australia Limited. We would like to thank the members of the Australian Hepatitis B Expert Panel for their input: Dr Paul Desmond, Professor Graeme Cooksley (Royal Brisbane Hospital, QLD), Dr Darrell Crawford (Princess Alexandra Hospital, QLD), Professor Geoffrey Farrell (Westmead Hospital, NSW), Associate Professor GW McCaughan (Royal Prince Alfred Hospital, NSW) and Dr William Sievert (Monash Medical Centre, VIC).

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Authors and Affiliations

  1. Glaxo Wellcome Australia, Melbourne, Victoria, Australia

    Steven J. Crowley & David Tognarini

  2. Centre for Health Program Evaluation, Boronia House, The Austin and Repatriation Medical Centre, The University of Melbourne, Banksia Street, Heidelberg, 3084, Victoria, Australia

    Steven J. Crowley

  3. Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia

    Paul V. Desmond

  4. Medical Technology Assessment Group, Sydney, New South Wales, Australia

    Michael Lees

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  1. Steven J. Crowley
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Correspondence to Steven J. Crowley.

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Crowley, S., Tognarini, D., Desmond, P.V. et al. Cost-Effectiveness Analysis of Lamivudine for the Treatment of Chronic Hepatitis B. Pharmacoeconomics 17, 409–427 (2000). https://doi.org/10.2165/00019053-200017050-00001

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