Cost-effectiveness of antiviral treatment after resection in hepatitis B virus-related hepatocellular carcinoma patients with compensated cirrhosis

Hepatocellular carcinoma (HCC) imposes a heavy disease burden on China due to its high morbidity and mortality. China accounts for about 50% of the total new cases and deaths worldwide. Most cases are related to hepatitis B virus (HBV) infection and are associated with cirrhosis at diagnosis. Antiviral treatment with nucleos(t)ide analogues (NAs) after resection in HBV-related HCC can reduce recurrence and improve survival. Such treatment is in fact recommended by Chinese guidelines. However, cost-effectiveness studies regarding this treatment are rare. The objective of this study was to estimate the cost-effectiveness of NA treatment after resection in HBV-related HCC patients with compensated cirrhosis. A Markov model was constructed to simulate HBV-related HCC patients with compensated cirrhosis and detectable HBV DNA, with or without NA treatment after resection, followed up over their lifetime. Costs, life expectancy, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER) were calculated for each strategy from the societal perspective. The parameters of the model were derived from published studies, government documents, and our surveys. Sensitivity analyses were used to explore the impact of parameters on the uncertainty of the results. NA treatment produced 4.22 QALYs, costing $39,898, while non-NA treatment achieved 2.80 QALYs, costing $16,048. The ICER of NA treatment versus non-NA treatment was $16,848/QALY, which was between 2 and 3 times gross domestic product per capita and was therefore deemed cost-effective. Probabilistic sensitivity analysis confirmed that NA treatment was cost-effective, with a probability of 0.852. Conclusion: NA treatment after liver resection was likely cost-effective in HBV-related HCC patients with compensated cirrhosis. (Hepatology 2018).