A Cost-Utility and Cost-Effectiveness Analysis of Different Oral Antiviral Medications in Patients With HBeAg-Negative Chronic Hepatitis B in Iran: An Economic Microsimulation Decision Model

Keshavarz, Khosro; Kebriaeezadeh, Abbas; Alavian, Seyed Moayed; Sari, Ali Akbari; Hemami, Mohsen Rezaei; Lotfi, Farhad; Meshkini, Amir Hashemi; Javanbakht, Mehdi; Keshvari, Maryam; Nikfar, Shekoufeh

doi:10.5812/hepatmon.37435

Cited by 10 publications

(6 citation statements)

References 49 publications

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“…In chronic hepatitis B, cost per QALY of medications ranged from $3474.78 in Tenofovir (TDF) to $10359.24 in Entecavir (ETV) in patients with HBeAg-negative chronic Hepatitis B from society perspective. Thus, TDF in patients with HBeAg-negative CHB is a highly cost-effective strategy [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

QALY league table of Iran: a practical method for better resource allocation

Hashempour

Raei

Lari

et al. 2021

Cost Eff Resour Alloc

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Background The limited health care resources cannot meet all the demands of the society. Thus, decision makers have to choose feasible interventions and reject the others. We aimed to collect and summarize the results of all cost utility analysis studies that were conducted in Iran and develop a Quality Adjusted Life Year (QALY) league table. Methods A systematic mapping review was conducted to identify all cost utility analysis studies done in Iran and then map them in a table. PubMed, Embase, Cochrane library, Web of Science, as well as Iranian databases like Iran Medex, SID, Magiran, and Barakat Knowledge Network System were all searched for articles published from the inception of the databases to January 2020. Additionally, Cost per QALY or Incremental Cost Utility Ratio (ICUR) were collected from all studies. The Joanna Briggs checklist was used to assess quality appraisal. Results In total, 51 cost-utility studies were included in the final analysis, out of which 14 studies were on cancer, six studies on coronary heart diseases. Two studies, each on hemophilia, multiple sclerosis and rheumatoid arthritis. The rest were on various other diseases. Markov model was the commonest one which has been applied to in 45% of the reviewed studies. Discount rates ranged from zero to 7.2%. The cost per QALY ranged from $ 0.144 in radiography costs for patients with some orthopedic problems to $ 4,551,521 for immune tolerance induction (ITI) therapy in hemophilia patients. High heterogeneity was revealed; therefore, it would be biased to rank interventions based on reported cost per QALY or ICUR. Conclusions However, it is instructive and informative to collect all economic evaluation studies and summarize them in a table. The information on the table would in turn be used to redirect resources for efficient allocation. in general, it was revealed that preventive programs are cost effective interventions from different perspectives in Iran.

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Section: Resultsmentioning

confidence: 99%

QALY league table of Iran: a practical method for better resource allocation

Hashempour

Raei

Lari

et al. 2021

Cost Eff Resour Alloc

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“…Table 4 presents an overview of the 15 studies that explicitly mentioned HBsAg loss health state utilities. Four were conducted using China as their country perspective [ 27 , 31 , 32 , 34 ], three studies were conducted using a US country perspective [ 46 – 48 ], three were conducted using a UK perspective [ 33 , 43 , 45 ], two were conducted using a Canadian perspective [ 38 , 40 ] and the remaining three studies used an Australian [ 29 ], Iranian [ 30 ] and Italian [ 36 ] country perspective, respectively.…”

Section: Resultsmentioning

confidence: 99%

Are Published Health Economic Models for Chronic Hepatitis B Appropriately Capturing the Benefits of HBsAg Loss? A Systematic Literature Review

Wigfield¹,

Sbarigia

Hashim³

et al. 2019

PharmacoEconomics Open

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Objectives Sustained hepatitis B surface antigen (HBsAg) loss or 'functional cure' (FC) is considered an optimal treatment endpoint by international clinical guidelines for chronic hepatitis B (CHB), yet rarely is this achieved with current standard of care (SoC). This leads to an under-reporting of FC in clinical trials, observational studies and health economic (HE) models. This paper systematically identifies and assesses how FC is incorporated in published HE models of CHB. Methods A systematic literature review was conducted in PubMed and Embase (conducted February 2019) to review how HBsAg loss is captured in HE models. The following items were extracted: rate of (and transition probabilities to) HBsAg loss, HBsAg loss health state costs, and HBsAg loss health state utilities. Results Sixty-five economics evaluations were identified, and < 50% of these (27/65) incorporated HBsAg loss in their models. Only 15/27 stated HBsAg loss health state costs, 15/27 stated HBsAg loss health state utilities, and 11/27 mentioned treatment-specific transition probabilities to HBsAg loss. The majority of sources these inputs were derived from are not transparent. Conclusions The benefits of FC in current HE models are not well captured, as FC is often not reported or not directly related to modelled treatments. This has the potential for novel agents with higher efficacy compared with SoC to be overlooked and undervalued if their worth is not appropriately communicated. In order to ensure optimal access for patients to new and effective therapies, it is important that the benefits of FC are better assessed and captured within HE models.Peter Wigfield and Urbano Sbarigia contributed equally to the work.The benefits of functional cure in current health economic models are not well captured, as functional cure is often not reported or not directly related to modelled treatments.In order to ensure optimal access for patients to new and effective therapies, it is important that the benefits of functional cure are better assessed and captured within health economic models.

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“…On the other hand, the scatter plot provides more detailed information in individual comparisons. It indicates the percentage of the points in the acceptance area, i.e., below the threshold [ 32 ].…”

Section: Methodsmentioning

confidence: 99%

Cost-Effectiveness Analysis of Biopharmaceuticals for Treating Rheumatoid Arthritis: Infliximab, Adalimumab, and Etanercept

Gholami

Azizpoor

Aflaki

et al. 2021

BioMed Research International

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Introduction. Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease that causes joint destruction. The condition imposes a significant economic burden on patients and societies. The present study is aimed at evaluating the cost-effectiveness of Infliximab, Adalimumab, and Etanercept in treating rheumatoid arthritis in Iran. Methods. This is a cost-effectiveness study of economic evaluation in which the Markov model was used. The study was carried out on 154 patients with rheumatoid arthritis in Fars province taking Infliximab, Adalimumab, and Etanercept. The patients were selected through sampling. In this study, the cost data were collected from a community perspective, and the outcomes were the mean reductions in DAS-28 and QALY. The cost data collection form and the EQ-5D questionnaire were also used to collect the required data. The results were presented in the form of an incremental cost-effectiveness ratio, and the sensitivity analysis was used to measure the robustness of the study results. The TreeAge Pro and Excel softwares were used to analyze the collected data. Results. The results showed that the mean costs and the QALY rates in the Infliximab, Adalimumab, and Etanercept arms were $ 79,518.33 and 12.34, $ 91,695.59 and 13.25, and $ 87,440.92 and 11.79, respectively. The one-way sensitivity analysis confirmed the robustness of the results. In addition, the results of the probabilistic sensitivity analysis (PSA) indicated that on the cost-effectiveness acceptability curve, Infliximab was in the acceptance area and below the threshold in 77% of simulations. The scatter plot was in the mentioned area in 81% and 91% of simulations compared with Adalimumab and Etanercept, respectively, implying lower costs and higher effectiveness than the other two alternatives. Therefore, the strategy was more cost-effective. Conclusion. According to the results of this study, Infliximab was more cost-effective than the other two medications. Therefore, it is recommended that physicians use this medication as the priority in treating rheumatoid arthritis. It is also suggested that health policymakers consider the present study results in preparing treatment guidelines for RA.

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A Cost-Utility and Cost-Effectiveness Analysis of Different Oral Antiviral Medications in Patients With HBeAg-Negative Chronic Hepatitis B in Iran: An Economic Microsimulation Decision Model

Cited by 10 publications

References 49 publications

QALY league table of Iran: a practical method for better resource allocation

QALY league table of Iran: a practical method for better resource allocation

Are Published Health Economic Models for Chronic Hepatitis B Appropriately Capturing the Benefits of HBsAg Loss? A Systematic Literature Review

Cost-Effectiveness Analysis of Biopharmaceuticals for Treating Rheumatoid Arthritis: Infliximab, Adalimumab, and Etanercept

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