Cost effectiveness of entecavir versus lamivudine with adefovir salvage in HBeAg-positive chronic hepatitis B

被引:49
作者
Veenstra, David L.
Sullivan, Sean D.
Clarke, Lauren
Iloeje, Uche H.
Tafesse, Eskinder
Di Bisceglie, Adrian
Kowdley, Kris V.
Gish, Robert G.
机构
[1] Univ Washington, Dept Pharm, Pharmaceut Outcomes Res & Policy Program, Seattle, WA 98195 USA
[2] Bristol Myers Squibb Pharmaceut Res Inst, Wallingford, CT USA
[3] St Louis Univ, Sch Med, Div Gastroenterol & Hepatol, St Louis, MO USA
[4] Univ Washington, Sch Med, Div Gastroenterol, Seattle, WA USA
[5] Calif Pacific Med Ctr, Div Hepatol & Complex GI, San Francisco, CA USA
关键词
D O I
10.2165/00019053-200725110-00006
中图分类号
F [经济];
学科分类号
02 ;
摘要
Objective: To evaluate the cost effectiveness of treatment of hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) with entecavir compared with lamivudine with adefovir salvage, based primarily on the results of a recent 2-year, randomised, multicentre, clinical trial (n = 709). Previous economic analyses have been limited by the lack of comparative clinical data for entecavir and lamivudine beyond 1-year duration and for salvage therapy. Methods: We conducted a cost-utility analysis using a Markov model from a US-payer perspective over a lifetime time horizon. The hypothetical cohort was 35-year-old patients with HBeAg-positive CHB. We evaluated 2 years of treatment with entecavir 0.5mg/day versus lamivudine 100mg/day, plus addition of adefovir 10mg/day for patients who developed virologic breakthrough due to resistance to either drug. In a scenario analysis, we considered adefovir plus lamivudine combination therapy for treatment-naive patients. Clinical and economic inputs ($US, year 2006 values) were derived from publicly available data, and probabilistic sensitivity analyses were conducted to evaluate uncertainty in the results. Results: The estimated 10-year cumulative incidence of cirrhosis for patients initiated on entecavir was 2.3% lower than for those on lamivudine (20.5% vs 22.8%). The discounted incremental cost per QALY gained was $US7600 in the base-case analysis, and the 95% central range from probabilistic sensitivity analysis was $US2500-$US19 100. Combination therapy for treatment-naive patients led to an increase in costs without improvement in patient outcomes compared with entecavir monotherapy. Conclusions: Our analysis suggests entecavir improves health outcomes in a cost-effective manner compared with lanlivudine with adefovir salvage or combination therapy, and highlights the importance of using evidence-based effectiveness estimates in economic studies of CHB therapies.
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收藏
页码:963 / 977
页数:15
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