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Economic analysis between entecavir and lamivudine for the treatment of chronic hepatitis B in Hong Kong

Authors


  • Authors’ declaration of personal interests

  • Kenneth KC Lee has received research funding to perform health economic studies from AstraZeneca, Bayer, BMS, Boehringer Ingelheim, Eisai, GlaxoSmithKline, Merck Sharp and Dohme, Janssen Pharmaceutica, Novartis, Pfizer, Roche, Schering-Plough and Wyeth and has acted as a consultant or speaker on occasions for AstraZeneca, GlaxoSmithKline, Janssen Pharmaceutica, Novartis, Pfizer, Sanofi-Aventis, Schering-Plough and Wyeth.

  • Declaration of funding interests

  • This study was funded in part by an unrestricted educational grant from BMS Hong Kong.

Professor Kenneth Kwing Chin Lee, Monash University, Jalan Lagoon Selatan, Bandar, Sunway, 46150, Selangor Darul Ehsan, Malaysia. Email: kenneth.lee@med.monash.edu.my

Abstract

Background and Aim:  Tremendous healthcare resources have been spent on the management of chronic hepatitis B (CHB) and its related complications. Therefore, a proper evaluation of the cost-effectiveness of pharmacotherapy is vital in aid of decision-making. The aim of the present study was to examine the long-term economic and clinical influence if lamivudine was replaced by entecavir in a group of CHB patients.

Methods:  A recently published decision analytic model was adapted to study the cost-effectiveness of 2 years of treatment of entecavir in a hypothetical cohort of 1000 hepatitis B e antigen (HBeAg)-negative CHB patients from a public hospital perspective. Compensated cirrhosis (CC) and de-compensated cirrhosis (DC) and hepatocellular carcinoma (HCC) events were projected to 10 years. Hong Kong-specific health care costs were used. Quality Adjusted Life Years (QALYs) were calculated using the utility values obtained from a local study.

Results:  In the base case analysis, compared with lamivudine, the use of entecavir was expected to reduce the incidences of CC, DC and HCC by 41.8%, 57.1% and 49.3%, respectively, and lead to a saving of $US 1.17 million in medical cost. The overall disease management cost for entecavir, which was 67.7% higher than lamivudine for 2 years treatment was reduced to 17.2% after projecting 2-year treatment duration to 10 years. The incremental cost per QALY gained for entecavir compared with lamivudine was $US 13 759.

Conclusions:  Based on the recommended cost-effectiveness threshold of the World Health Organization, entecavir is considered cost-effective compared with lamivudine in treating CHB in Hong Kong when long term medical consequences were considered.

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