Telbivudine for the treatment of chronic hepatitis B in HBeAg-positive patients in China: a health economic analysis

Abstract

BackgroundNucleos(t)ide analogs (NUCs) are the standard of care for chronic hepatitis B (CHB). The present analysis aimed to determine the cost effectiveness of NUCs in Chinese healthcare settings.MethodsA Markov model was used to simulate two therapeutic strategies for a hypothetical patient cohort diagnosed with hepatitis B e antigen-positive CHB, unwilling or unable to receive interferon therapy, and about to start treatment with any NUC. The first strategy included NUC monotherapy without sequencing (telbivudine [LDT], entecavir [ETV], tenofovir [TDF], lamivudine [LAM], adefovir dipivoxil [ADV], and combination therapies of either LDT and ADV or LDT and TDF, followed by best supportive care [BSC]). The second strategy included sequential therapies of individual NUCs: LAM → ADV, ADV → LAM, LDT → ADV, and ETV → ADV, followed by BSC. The analysis included two scenarios: with and without costs due to nephrotoxicity. Renal impact was quantified as costs alone, without consideration for quality of life decrements.ResultsWhen renal impact was not considered, without treatment sequencing, LDT was cost effective compared with other NUCs. Amongst the strategies with sequencing, LDT → ADV was cost effective. The results were similar when renal impact was considered. However, LDT strategy demonstrated better cost effectiveness. In probabilistic sensitivity analysis, in both scenarios, LDT → ADV sequence was cost effective with 51 % probability even at willingness to pay of $20,000.ConclusionUse of LDT, as compared with other NUCs, is cost effective in CHB treatment in Chinese healthcare settings. Considering the detrimental renal impact, overall costs for all treatment options were increased. However, the increase for LDT was comparatively small.

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“…However, ETV and TDF are not widely used, particularly in economically lessdeveloped regions due to the high daily cost or limited availability. As reported in a recent pharmacoeconomic evaluation, LtD treatment demonstrated better cost-effectiveness compared to other NAs for CHB in Chinese healthcare settings (78). Therefore, it represents a valid alternative drug with potent anti-viral activity and medium genetic barrier to resistance, particularly for the treatment of low viremic NA-naïve patients.…”

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

“…For all studies outlined in Table 4, the health state utility value specific to the HBsAg loss health state is reported. As seen, the utility values used in the studies range fairly substantially from 0.71 (reported in three studies [27,31,34]) to 0.99 (reported in four studies [32,[46][47][48]). As was undertaken for HBsAg health state costs, the sources these utilities were referenced from have been included in the table alongside a description of the study type.…”

“…In terms of type of economic analyses, the vast majority were cost utility analyses (50/65), with cost-effectiveness analyses making up only 12 of the total included studies [26,31,[52][53][54][55][56][57][58][59][60][61]. One study employed a perceived value assessment (PVA) method that is described by the authors as a novel health economics methodology developed by Monitor Deloitte (formerly Monitor Group) [27,62].…”

“…This is because of the heterogeneity of the baseline patient populations and study designs between trials, which will undoubtedly affect the outcomes explored. For TDF, annual HBsAg loss rates between 0.7% (Banerjee et al [31]) and 10% (Ruggeri et al [28]) are used in HBeAg-positive patients, with Colombo et al [41] and Ruggeri et al [28] presenting increasing annual rates beginning from 3% and 3.2% respectively in year one. In HBeAg negative patients, a 0% annual loss rate is used in Colombo et al [41] and a 12% lifetime loss rate is used by Lo et al [35].…”

“…For ADV, annual HBsAg loss rates ranged more conservatively between 0% (Colombo et al [41]) and 1.3% (Zhang et al [34] and Banerjee et al [31]) in HBeAg-positive patients. Again, Colombo et al [41] is the only study that reported a loss rate for HBeAg-negative patients (0%), whilst no studies reported a loss rate that was not specific to a particular HBeAg status.…”