Title |
Cost-Effectiveness and Clinical Impact of Antiviral Strategies of HBeAg-Positive and -Negative Chronic Hepatitis B.
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Published in |
Annals of hepatology official journal of the Mexican Association of Hepatology, January 2017
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DOI | 10.5604/16652681.1235478 |
Pubmed ID | |
Authors |
Itziar Oyagüez, María Buti, Max Brosa, Magdalena Rueda, Miguel A Casado |
Abstract |
Chronic hepatitis B (CHB) is associated with high burden and healthcare costs. Virologic response achieved with antivirals is associated with progression avoidance. This study aimed to estimate the efficiency and clinical impact of antiviral strategies in CHB patients. A Markov model estimated lifetime complications and direct costs in both, HBeAg-positive and HBeAg-negative cohorts. Strategy 1 (71% of treated population) and strategy 2 (100%), both based on pegylated interferon (peg-IFN) followed by oral tenofovir or entecavir, were compared to no treatment. Progression was based on HBV-DNA levels. Rescue therapy with oral antivirals was applied for peg-IFN failure. Disease costs (C, 2014) and utilities were obtained from literature. Compared to natural history, strategy 1 increased QALY (3.98 in HBeAg-positive, 2.16 in -negative cohort). With strategy 2, survival was up to 5.60 (HBeAg-positive) and 3.05 QALY (in HBeAg-negative). The model predicted avoidance of 128 and 86 carcinomas in HBeAg-positive and -negative patients with strategy 1, and up to 181 and 121 in HBeAg-positive and -negative for strategy 2. Total cost increased up to C102,841 (strategy 1) and C105,408 (strategy 2) in HBeAg-positive, and C85,858 and C93,754 in HBeAg-negative. A C1,581/QALY gained ratio was estimated versus the natural history for both strategies. In conclusion, increasing antiviral coverage would be efficient, reducing complications. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 36 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 6 | 17% |
Other | 4 | 11% |
Student > Bachelor | 4 | 11% |
Student > Master | 3 | 8% |
Student > Postgraduate | 2 | 6% |
Other | 2 | 6% |
Unknown | 15 | 42% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 9 | 25% |
Economics, Econometrics and Finance | 6 | 17% |
Nursing and Health Professions | 2 | 6% |
Agricultural and Biological Sciences | 1 | 3% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 3% |
Other | 2 | 6% |
Unknown | 15 | 42% |