Treatment Alternatives for Hepatitis B Cirrhosis: A Cost-Effectiveness Analysis

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Treatment Alternatives for Hepatitis B Cirrhosis: A Cost-Effectiveness

Analysis

Authors: Kanwal, Fasiha; Farid, ; , 1; Chen, 1; Gralnek,

Ian M.; Dulai, Gareth S.; Spiegel, Brennan M. R.

Source: The American Journal of Gastroenterology, Volume 101, Number 9,

September 2006, pp. 2076-2089(14)

Publisher: Blackwell Publishing

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Abstract:

BACKGROUND: & #8195;Hepatitis B virus (HBV) patients with cirrhosis are at

risk for developing costly, morbid, or mortal events, and therefore need

highly effective therapies. Lamivudine is effective but is limited by viral

resistance. In contrast, adefovir and entecavir have lower viral resistance,

but are more expensive. The most cost-effective approach is uncertain.

METHODS: & #8195;We evaluated the cost-effectiveness of six strategies in HBV

cirrhosis: (1) No HBV treatment (“do nothing”), (2) lamivudine monotherapy,

(3) adefovir monotherapy, (4) lamivudine with crossover to adefovir on

resistance (“adefovir salvage”), (5) entecavir monotherapy, or (6)

lamivudine with crossover to entecavir on resistance (“entecavir salvage”).

The primary outcome was the incremental cost per quality-adjusted life-year

(QALY) gained.

RESULTS: & #8195;The “do nothing” strategy was least effective yet least

expensive. Compared with “do nothing,” using adefovir cost an incremental

$19,731. Entecavir was more effective yet more expensive than adefovir, and

cost an incremental $25,626 per QALY gained versus adefovir. Selecting

between entecavir versus adefovir was highly dependent on the third-party

payer's “willingess-to-pay” (e.g., 45% and 60% of patients fall within

budget if willing-to-pay $10K and $50K per QALY gained for entecavir,

respectively). Both lamivudine monotherapy and the “salvage” strategies were

not cost-effective. However, between the two salvage strategies, “adefovir

salvage” was more effective and less expensive than “entecavir salvage.”

CONCLUSION: & #8195;Both entecavir and adefovir are cost-effective in patients

with HBV cirrhosis. Choosing between adefovir and entecavir is highly

dependent on available budgets. In patients with HBV cirrhosis with previous

lamivudine resistance, “adefovir salvage” appears more effective and less

expensive than “entecavir salvage.”

(Am J Gastroenterol 2006;101:2076-2089)

Document Type: Research article

DOI: 10.1111/j.1572-0241.2006.00769.x

Affiliations: 1: Cedars Sinai Medical Center, Los Angeles, California

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[Guest guest]

Treatment Alternatives for Hepatitis B Cirrhosis: A Cost-Effectiveness

Analysis

Authors: Kanwal, Fasiha; Farid, ; , 1; Chen, 1; Gralnek,

Ian M.; Dulai, Gareth S.; Spiegel, Brennan M. R.

Source: The American Journal of Gastroenterology, Volume 101, Number 9,

September 2006, pp. 2076-2089(14)

Publisher: Blackwell Publishing

< previous article | next article > | View Table of Contents

Article access options

Abstract:

BACKGROUND: & #8195;Hepatitis B virus (HBV) patients with cirrhosis are at

risk for developing costly, morbid, or mortal events, and therefore need

highly effective therapies. Lamivudine is effective but is limited by viral

resistance. In contrast, adefovir and entecavir have lower viral resistance,

but are more expensive. The most cost-effective approach is uncertain.

METHODS: & #8195;We evaluated the cost-effectiveness of six strategies in HBV

cirrhosis: (1) No HBV treatment (“do nothing”), (2) lamivudine monotherapy,

(3) adefovir monotherapy, (4) lamivudine with crossover to adefovir on

resistance (“adefovir salvage”), (5) entecavir monotherapy, or (6)

lamivudine with crossover to entecavir on resistance (“entecavir salvage”).

The primary outcome was the incremental cost per quality-adjusted life-year

(QALY) gained.

RESULTS: & #8195;The “do nothing” strategy was least effective yet least

expensive. Compared with “do nothing,” using adefovir cost an incremental

$19,731. Entecavir was more effective yet more expensive than adefovir, and

cost an incremental $25,626 per QALY gained versus adefovir. Selecting

between entecavir versus adefovir was highly dependent on the third-party

payer's “willingess-to-pay” (e.g., 45% and 60% of patients fall within

budget if willing-to-pay $10K and $50K per QALY gained for entecavir,

respectively). Both lamivudine monotherapy and the “salvage” strategies were

not cost-effective. However, between the two salvage strategies, “adefovir

salvage” was more effective and less expensive than “entecavir salvage.”

CONCLUSION: & #8195;Both entecavir and adefovir are cost-effective in patients

with HBV cirrhosis. Choosing between adefovir and entecavir is highly

dependent on available budgets. In patients with HBV cirrhosis with previous

lamivudine resistance, “adefovir salvage” appears more effective and less

expensive than “entecavir salvage.”

(Am J Gastroenterol 2006;101:2076-2089)

Document Type: Research article

DOI: 10.1111/j.1572-0241.2006.00769.x

Affiliations: 1: Cedars Sinai Medical Center, Los Angeles, California

_________________________________________________________________

Check the weather nationwide with MSN Search: Try it now!

http://search.msn.com/results.aspx?q=weather & FORM=WLMTAG