The economics of treating chronic hepatitis B in Asia

May 12, 2008

FULL TEXT LINK: http://www.springerlink.com/content/l302714255605664/

Journal Hepatology International

Publisher Springer New York

ISSN 1936-0533 (Print) 1936-0541 (Online)

Category Review Article

DOI 10.1007/s12072-008-9049-2

Subject Collection Medicine

SpringerLink Date Thursday, May 01, 2008

Yock Young Dan1, 2, Myat Oo Aung3 and Seng Gee Lim1, 2, 3

(1) Department of Gastroenterology and Hepatology, National University

Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

(2) Department of Medicine, Yong Loo Lin School of Medicine, National

University, Singapore, Singapore

(3) Centre for Molecular Medicine, Agency for Science, Technology and Research,

Singapore, Singapore

Received: 16 November 2007 Accepted: 18 January 2008 Published online: 1 May

2008

Abstract Chronic hepatitis B constitutes a significant health and economic

burden to Asian countries. Six medications are now approved for the treatment of

chronic hepatitis B, but there is still significant uncertainty with regards to

treatment outcomes, cost impact, and benefits in view of the absence of

long-term outcomes data. Cost-effectiveness Markov modeling thus allows us to

project and estimate long-term outcomes based on current data and compare the

cost–benefit between different treatment options. However, there are limitations

to these reported studies. Cost-utility indices such as cost/quality–adjusted

life years (cost/QALY) may not be intuitive to clinicians and patients. These

studies are also usually based on first-world economies, using a benchmark of

US$50,000/QALY, and cannot be extrapolated directly to Asia-Pacific countries.

Cost-effectiveness of various treatment strategies using a combination of

cost-effectiveness indices may provide a more complete picture. These include

cost/HBeAg seroconversion for HBeAg-positive patients (range: US$19,400–30,800)

and cost/HBV DNA negative (PCR assay) for HBeAg-negative patients (range:

US$14,400–32,000) over 5-year time horizon; cost per cirrhosis prevented (range:

US$326,000–686,000) and cost per HCC prevented (range: US$654,000–1,380,000)

over 10-year horizon using data from REVEAL study, cost per end point

complication prevented in cirrhotics (US$9,630/year), and cost per HCC prevented

in cirrhotics (US$ 27,600/year) over a 32-month horizon, using data from Asia

Lamivudine Cirrhosis Study. More potent antivirals with low resistance appear to

have lower cost/clinical end point averted. Published reports of cost-utility

analysis comparing treatment using conventional cost/QALY show that all

treatment modalities fall below the first-world benchmark of US$50,000/QALY but

vary in modeling assumptions and in quality, making comparisons difficult.

Reimbursement policies affect out-of-pocket expenses to the patient, and

increases the proportion of patients who can afford therapy, but generally do

not affect cost-effectiveness. In conclusion, cost-effectiveness analysis is an

important tool for health care administrators, clinicians, and patients to

decide on the optimal therapy for chronic hepatitis B, but the methodology

permits considerable leeway for interpretation of results, thus a combination of

cost-effective indices may be needed to paint a more complete picture.

Keywords Hepatitis B treatment - Cost-effectiveness analysis

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Seng Gee Lim

Email: mdclimsg@...

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May 12, 2008