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Prophylactic strategies for hepatitis B patients undergoing liver transplant: A cost-effectiveness analysis
Article first published online: 20 APR 2006
DOI: 10.1002/lt.20685
Copyright © 2006 American Association for the Study of Liver Diseases
Additional Information
How to Cite
Dan, Y. Y., Wai, C. T., Yeoh, K. G. and Lim, S. G. (2006), Prophylactic strategies for hepatitis B patients undergoing liver transplant: A cost-effectiveness analysis. Liver Transpl, 12: 736–746. doi: 10.1002/lt.20685
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Publication History
- Issue published online: 20 APR 2006
- Article first published online: 20 APR 2006
- Manuscript Accepted: 30 NOV 2005
- Manuscript Received: 1 JUL 2005
Funded by
- National University of Singapore. Grant Number: R-172-000-001-731
- Health Resources and Services Administration. Grant Number: 231-00-0115
- Abstract
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Abstract
Hepatitis B immunoglobulin with lamivudine prophylaxis (LAM/HBIG) is effective in preventing Hepatitis B (HBV) recurrence posttransplant but is expensive and inconvenient. Lamivudine-resistant HBV, which has limited the usefulness of lamivudine monoprophylaxis in transplant, can now be effectively controlled with adefovir dipivoxil. We performed a cost-effectiveness analysis on the strategies of lamivudine prophylaxis with adefovir rescue(LAM/ADV) compared to combination LAM/intravenous fixed high-dose HBIG prophylaxis(LAM/ivHBIG) or LAM/intramuscular HBIG prophylaxis(LAM/imHBIG). Markov modeling was performed with analysis from societal perspective. Probability rates were derived from systematic review of the literature and cost taken from MEDICARE database. Outcome measures were incremental cost-effectiveness ratio(ICER) and cost to prevent each HBV recurrence and death. Analysis was performed at 5 years posttransplant as well as at end of life expectancy (15 years). Combination LAM/ivHBIG cost an additional USD562,000 at 15 years, while LAM/imHBIG cost an additional USD139,000 per patient compared to LAM/ADV. Although there is an estimated increase in recurrence of 53% with LAM/ADV and 7.6% increased mortality at the end of life expectancy (15 years), the ICER of LAM/ivHBIG over LAM/ADV treatment is USD760,000 per quality-adjusted life-years and for LAM/imHBIG, USD188,000. Cost-effectiveness is most sensitive to cost of HBIG. Lamivudine prophylaxis with adefovir dipivoxil salvage offers the more cost-effective option for HBV patients undergoing liver transplant but with higher recurrence and death rate using a model that favors LAM/HBIG. Lowering the cost of HBIG maintenance will improve cost-effectiveness of LAM/HBIG strategy. In conclusion, a tailored approach based on individual risks will optimize the cost-benefit of HBV transplant prophylaxis. Liver Transpl 12:736–746, 2006. © 2006 AASLD.