Cost-effectiveness of antiviral treatment in adult patients with immune-tolerant phase chronic hepatitis B

Abstract

ObjectiveThe cost-effectiveness of antiviral treatment in adult immune-tolerant (IT) phase chronic hepatitis B (CHB) patients is uncertain.DesignWe designed a Markov model to compare expected costs and quality-adjusted life-years (QALYs) of starting antiviral treatment at IT-phase (‘treat-IT’) vs delaying the therapy until active hepatitis phase (‘untreat-IT’) in CHB patients over a 20-year horizon. A cohort of 10 000 non-cirrhotic 35-year-old patients in IT-phase CHB (hepatitis B e antigen-positive, mean serum hepatitis B virus (HBV) DNA levels 7.6 log10 IU/mL, and normal alanine aminotransferase levels) was simulated. Input parameters were obtained from previous studies at Asan Medical Center, Korea. The incremental cost-effectiveness ratio (ICER) between the treat-IT and untreat-IT strategies was calculated.ResultsFrom a healthcare system perspective, the treat-IT strategy with entecavir or tenofovir had an ICER of US$16 516/QALY, with an annual hepatocellular carcinoma (HCC) incidence of 0.73% in the untreat-IT group. With the annual HCC risk ≥0.54%, the treat-IT strategy was cost-effective at a willingness-to-pay threshold of US$20 000/QALY. From a societal perspective considering productivity loss by premature death, the treat-IT strategy was extremely cost-effective, and was dominant (ICER <0) if the HCC risk was ≥0.43%, suggesting that the treat-IT strategy incurs less costs than the untreat-IT strategy. The most influential parameters on cost-effectiveness of the treat-IT strategy were those related with HCC risk (HBV DNA levels, platelet counts and age) and drug cost.ConclusionStarting antiviral therapy in IT phase is cost-effective compared with delaying the treatment until the active hepatitis phase in CHB patients, especially with increasing HCC risk, decreasing drug costs and consideration of productivity loss.

Secondary prevention of hepatitis B virus‐related hepatocellular carcinoma with current antiviral therapies

“…Our recent cost‐effectiveness analysis indicated that earlier treatment initiation with normal ALT levels and high viral load may be cost‐effective compared with deferring the treatment until the appearance of active hepatitis phase in adult patients with CHB, 70 considering highly potent long‐term efficacy and safety of current anti‐HBV drugs that have high genetic barrier to resistance and decreasing cost 71–73 . In accordance, overall medication adherence rate in CHB patients has been consistently reported to be high (>90%) by many previous studies 74–76 …”

Effectiveness of Tenofovir Alafenamide in Chronic Hepatitis B Patients with Normal Alanine Aminotransferase and Positive Hepatitis B Virus DNA

“… 26 Similarly, compared with delaying treatment until progression to active hepatitis phase in CHB patients, starting antiviral therapy in the immune-tolerant phase is more cost-effective, decreasing drug costs and affecting productivity loss. 27 With decreasing cost of nucleos(t)ide analog in the forthcoming years, the cost-effectiveness of treatment could be further improved. TAF was listed in China’s medical insurance reimbursement catalog (patients paid about 647-3,234 RMB per year) in December 2019, so it is reasonable to believe that TAF, a cost-effective regimen of antiviral therapy, is currently available.…”

Chronic Hepatitis B: Challenges and Successes in India

“…If the individual does not infect others with HBV, the “resistance” cannot spread. Even if therapy is given lifelong, it is cost‐effective in Asian countries because it offsets the direct health care costs of managing late complications, such as decompensation, HCC, admissions, and transplantation, and the indirect costs of low economic productivity and wage losses because of CHB 18 …”