Cost Effectiveness of Entecavir versus Lamivudine with Adefovir Salvage in HBeAg-Positive Chronic Hepatitis B

• Published in: PharmacoEconomics 2007-01, Vol.25 (11), p.963-977
• Main Authors: VEENSTRA, David L, SULLIVAN, Sean D, CLARKE, Lauren, ILOEJE, Uche H, TAFESSE, Eskinder, DI BISCEGLIE, Adrian, KOWDLEY, Kris V, GISH, Robert G
• Format: Article
• Language: English
• Subjects: Adefovir; Adenine - analogs & derivatives; Adenine - economics; Adenine - therapeutic use; Anti-HIV Agents - economics; Anti-HIV Agents - therapeutic use; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - economics; Antiviral Agents - therapeutic use; Biological and medical sciences; Cohort Studies; Cost-Benefit Analysis; Cost-utility; Disease Progression; Entecavir; Guanine - analogs & derivatives; Guanine - economics; Guanine - therapeutic use; Health technology assessment; Hepatitis B e Antigens - metabolism; Hepatitis B, Chronic - drug therapy; Hepatitis B, Chronic - economics; Hepatitis-B; Human viral diseases; Humans; Infectious diseases; Lamivudine; Lamivudine - economics; Lamivudine - therapeutic use; Markov Chains; Medical sciences; Organophosphonates - economics; Organophosphonates - therapeutic use; Pharmacology. Drug treatments; Quality of Life; Research-and-development; Salvage Therapy - economics; Viral diseases; Viral hepatitis
• ISSN: 1170-7690; 1179-2027
• DOI: 10.2165/00019053-200725110-00006

To evaluate the cost effectiveness of treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) with entecavir compared with lamivudine with adefovir salvage, based primarily on the results of a recent 2-year, randomised, multicentre, clinical trial (n = 709). Previous economic analyses have been limited by the lack of comparative clinical data for entecavir and lamivudine beyond 1-year duration and for salvage therapy. We conducted a cost-utility analysis using a Markov model from a US-payer perspective over a lifetime time horizon. The hypothetical cohort was 35-year-old patients with HBeAg-positive CHB. We evaluated 2 years of treatment with entecavir 0.5mg/day versus lamivudine 100mg/day, plus addition of adefovir 10mg/day for patients who developed virologic breakthrough due to resistance to either drug. In a scenario analysis, we considered adefovir plus lamivudine combination therapy for treatment-naive patients. Clinical and economic inputs ($US, year 2006 values) were derived from publicly available data, and probabilistic sensitivity analyses were conducted to evaluate uncertainty in the results. The estimated 10-year cumulative incidence of cirrhosis for patients initiated on entecavir was 2.3% lower than for those on lamivudine (20.5% vs 22.8%). The discounted incremental cost per QALY gained was $US7600 in the base-case analysis, and the 95% central range from probabilistic sensitivity analysis was $US2500-$US19 100. Combination therapy for treatment-naive patients led to an increase in costs without improvement in patient outcomes compared with entecavir monotherapy. Our analysis suggests entecavir improves health outcomes in a cost-effective manner compared with lamivudine with adefovir salvage or combination therapy, and highlights the importance of using evidence-based effectiveness estimates in economic studies of CHB therapies.