Cost-Effectiveness and Clinical Impact of Antiviral Strategies of HBeAG-Positive and Negative Chronic Hepatitis B
Ann. hepatol
;
16(3): 358-365, May.-Jun. 2017. tab, graf
Article
Dans Anglais
| LILACS
| ID: biblio-887247
ABSTRACT
ABSTRACT Introduction. Chronic hepatitis B (CHB) is associated with high burden and healthcare costs. Virologic response achieved with antivirals is associated with progression avoidance. This study aimed to estimate the efficiency and clinical impact of antiviral strategies in CHB patients. Material and methods. A Markov model estimated lifetime complications and direct costs in both, HBeAg-positive and HBeAg-negative cohorts. Strategy 1 (71% of treated population) and strategy 2 (100%), both based on pegylated interferon (peg-IFN) followed by oral tenofovir or entecavir, were compared to no treatment. Progression was based on HBV-DNA levels. Rescue therapy with oral antivirals was applied for peg-IFN failure. Disease costs (€, 2014) and utilities were obtained from literature. Results. Compared to natural history, strategy 1 increased QALY (3.98 in HBeAg-positive, 2.16 in -negative cohort). With strategy 2, survival was up to 5.60 (HBeAg-positive) and 3.05 QALY (in HBeAg-negative). The model predicted avoidance of 128 and 86 carcinomas in HBeAg-positive and -negative patients with strategy 1, and up to 181 and 121 in HBeAg-positive and -negative for strategy 2. Total cost increased up to €102,841 (strategy 1) and €105,408 (strategy 2) in HBeAg-positive, and €85,858 and €93,754 in HBeAg-negative. A€1,581/QALY gained ratio was estimated versus the natural history for both strategies. In conclusion, increasing antiviral coverage would be efficient, reducing complications.
Texte intégral:
Disponible
Indice:
LILAS (Amériques)
Sujet Principal:
Virus de l'hépatite B
/
Coûts des médicaments
/
Hépatite B chronique
/
Antigènes e du virus de l'hépatite virale B
Type d'étude:
Évaluation en économique de la santé
/
Étude pronostique
Limites du sujet:
Humains
langue:
Anglais
Texte intégral:
Ann. hepatol
Thème du journal:
Gastroentérologie
Année:
2017
Type:
Article
Pays d'affiliation:
Espagne
Institution/Pays d'affiliation:
Pharmacoeconomics & Outcomes Research Iberia/ES
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