Cost-effectiveness analysis of lamivudine and adefovir dipivoxil in the treatment of patients with HBeAg-negative chronic hepatitis B

Authors


Dr M. Buti, Servicio de Hepatología, Hospital Vall d'Hebrón, Paseo Vall d'Hebrón s/n, 08035 Barcelona, Spain.
E-mail: mbuti@vhebron.net

Abstract

Summary

Aim

To estimate the cost-effectiveness over a 4-year duration of lamivudine and adefovir dipivoxil for patients with hepatitis B ‘e’ antigen-negative chronic hepatitis B.

Methods

A decision analysis model has been used to perform a cost-effectiveness analysis of lamivudine and adefovir dipivoxil from the perspective of the Spanish Public Health System. Data were obtained from clinical trials.

Results

For the base-case, the total estimated cost per patient treated with lamivudine or adefovir dipivoxil for 4 years was €11 457 and €21 939 respectively. Virological response at year 4 for the lamivudine arm was 40.4% and 78.0% for the adefovir dipivoxil arm. The average cost-effectiveness ratio (cost per responding patient at year 4) was €28 375 for the lamivudine arm and €28 132 for the adefovir dipivoxil arm. The incremental cost-effectiveness ratio of adefovir dipivoxil vs. lamivudine (cost per additional responding patient with adefovir dipivoxil) was €27 872, demonstrating that this cost was slightly lower than the average cost-effectiveness ratios of adefovir dipivoxil or lamivudine. The sensitivity analysis demonstrated that the factors that most influence the cost-effectiveness were the response to adefovir dipivoxil and lamivudine at year 4.

Conclusion

Long-term treatment with adefovir dipivoxil is a cost-effective strategy in patients with chronic hepatitis B ‘e’ antigen-negative hepatitis.

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