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SHOULD CHRONIC HEPATITIS B BE TREATED AS EARLY AS POSSIBLE?

Published online by Cambridge University Press:  08 January 2013

Frank Hulstaert ,
Christoph Schwierz ,
Frederik Nevens ,
Nancy Thiry ,
Mohamed Gamil ,
Isabelle Colle ,
Stefaan Van de Sande  and
Yves Horsmans
Frank Hulstaert
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Christoph Schwierz
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Frederik Nevens
Affiliation:
Hepatology, UZ Gasthuisberg, KU Leuven
Nancy Thiry
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Mohamed Gamil
Affiliation:
Hepatology, UZ Gasthuisberg, KU Leuven
Isabelle Colle
Affiliation:
Hepatology, University Hospital Ghent
Stefaan Van de Sande
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Yves Horsmans
Affiliation:
Hepatology, University Hospital Saint-Luc, Brussels
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Abstract

Objectives: We studied the cost-effectiveness of tenofovir and entecavir in e antigen positive (CHBe+) and negative (CHBe-) chronic hepatitis B.

Methods: Using a multicenter survey including 544 patients we measured patient quality of life and attributable costs by clinical disease stage. Natural disease progression was studied in 278 patients in a single center. A Markov model was constructed to follow hypothetical cohorts of treated and untreated 40-year-old CHBe+ and CHBe- patients and 50-year-old patients with compensated cirrhosis.

Results: We did not find an improvement in quality of life when viral load was reduced under treatment. Transition rates to liver cirrhosis were found to be age-dependent. Assuming equal effectiveness, tenofovir dominates the entecavir strategy because of its lower price in Belgium. The incremental cost-effectiveness ratio (ICER) of tenofovir after 20 years is more favorable for treating Caucasian cirrhotic patients (mean ICER €29,000/quality-adjusted life-year [QALY]) compared with treating non-cirrhotic patients (mean ICER €110,000 and 131,000/QALY for CHB e+ and e-, respectively). Within the non-cirrhotic patients the ICER decreases with increasing cohort starting age from 30 to 50 years.

Conclusions: Results of long-term models for tenofovir or entecavir treatment of CHB need to be interpreted with caution as long-term trials with hard end points are lacking. Especially the effect on HCC remains highly uncertain. Based on cost-effectiveness considerations such antiviral treatment should be targeted at patients with cirrhosis or at risk of rapid progression to this disease stage.

Keywords

Chronic hepatitis BAntiviral treatmentTenofovirEntecavirCost-effectiveness analysisCost-utility analysisQuality of lifeNatural disease progression
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 1 , January 2013 , pp. 35 - 41
Copyright
Copyright © Cambridge University Press 2013

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References

REFERENCES

1.European Association for the Study of the Liver (EASL). Clinical Practice Guidelines: management of chronic hepatitis B virus infection. J Hepatol. 2012;57:167–85.CrossRefGoogle Scholar
2.Horsmans, Y, Thiry, N, le Polain, Met al. Cost-effectiveness of antiviral treatment of chronic hepatitis B in Belgium. Part 1: Literature review and results of a national study. Health Technology Assessment (HTA). Brussels: Federal Healthcare Knowledge Centre (KCE). KCE reports 127C. [cited 2012 November 23]. Available from: https://kce.fgov.be/publication/report/cost-effectiveness-of-antiviral-treatment-of-chronic-hepatitis-b-in-belgium-part-; 2010.Google Scholar
3.Colombo, M. Does chemotherapy prevent HBV-related hepatocellular carcinoma? Cons. Dig Liver Dis. 2010;42 (Suppl 3):S298–301.CrossRefGoogle ScholarPubMed
4.Schwierz, C, Thiry, N, Van de Sande, Set al. Economic evaluation of antiviral treatment of chronic hepatitis B in Belgium – Part 2. Health Technology Assessment (HTA). Brussels: Federal Healthcare Knowledge Centre (KCE). KCE reports 157C. [cited 2012 November 23]. Available from: https://kce.fgov.be/publication/report/economic-evaluation-of-antiviral-treatment-of-chronic-hepatitis-b-in-belgium; 2010.Google Scholar
5.Fattovich, G, Bortolotti, F, Donato, F. Natural history of chronic hepatitis B: special emphasis on disease progression and prognostic factors. J Hepatol. 2008;48:335–52.CrossRefGoogle ScholarPubMed
6.McMahon, BJ. The natural history of chronic hepatitis B virus infection. Hepatology. 2009;49 (Suppl):S45–55.CrossRefGoogle ScholarPubMed
7.Colle, I, Adler, M, Brenard, R, et al.Management and treatment of chronic hepatitis B virus: Belgian Association for the Study of the Liver (BASL) 2007 guidelines. Acta Gastroenterol Belg. 2007;70:389–420.Google Scholar
8.Spackman, DE, Veenstra, DL. A cost-effectiveness analysis of currently approved treatments for HBeAg-positive chronic hepatitis B. Pharmacoeconomics. 2008;26:937–49.CrossRefGoogle ScholarPubMed
9.Veenstra, DL, Spackman, DE, Bisceglie, A, Kowdley, KV, Gish, RG. Evaluating anti-viral drug selection and treatment duration in HBeAg-negative chronic hepatitis B: A cost-effectiveness analysis. Aliment Pharmacol Ther. 2008;27:1240–52.CrossRefGoogle ScholarPubMed
10.Arnold, E, Yuan, Y, Iloeje, U, Cook, G. Cost-effectiveness analysis of entecavir versus lamivudine in the first-line treatment of Australian patients with chronic hepatitis B. Appl Health Econ Health Policy. 2008;6:231–46.CrossRefGoogle ScholarPubMed
11.Orlewska, E, Zammit, D, Yuan, Y, et al.The cost-effectiveness analysis of entecavir in the treatment of chronic hepatitis B (CHB) patients in Poland. Exp Clin Hepatol. 2008;4:20–8.Google Scholar
12.Costa, AMN, L ‘italien, G, Nita, ME, Araujo, ESA. Cost-effectiveness of entecavir versus lamivudine for the suppression of viral replication in chronic hepatitis B patients in Brazil. Braz J Infect Dis. 2008;12:368–73.CrossRefGoogle ScholarPubMed
13.Buti, M, Brosa, M, Casado, MA, Rueda, M, Esteban, R. Modeling the cost-effectiveness of different oral antiviral therapies in patients with chronic hepatitis B. J Hepatol. 2009;51:640–6.CrossRefGoogle ScholarPubMed
14.Veenstra, DL, Sullivan, SD, Lai, M-Y, et al.HBeAg-negative chronic hepatitis B: cost-effectiveness of peginterferon alfa-2a compared to lamivudine in Taiwan. Value Health. 2008;11:131–8.CrossRefGoogle ScholarPubMed
15.Lacey, LF, Gane, E. The cost-effectiveness of long-term antiviral therapy in the management of HBeAg-positive and HBeAg-negative chronic hepatitis B in Singapore. J Viral Hepat. 2007;14:751–66.CrossRefGoogle ScholarPubMed
16.Lacey, L, Chien, R-N, Chuang, W-L, Pwu, R-F. Economic evaluation of chronic hepatitis B treatments in Taiwan. J Gastroenterol Hepatol. 2008;23:571-9.CrossRefGoogle ScholarPubMed
17.Dakin, H, Bentley, A, Dusheiko, G. Cost-utility analysis of tenofovir disoproxil fumarate in the treatment of chronic hepatitis B. Value Health. 2010;13:922–33.CrossRefGoogle ScholarPubMed
18.Levy, AR, Kowdley, KV, Iloeje, U, et al.The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value Health. 2008;11:527–38.CrossRefGoogle ScholarPubMed
19.Post, SE, Sodhi, NK, Peng, C-H, Wan, K, Pollack, HJ. A simulation shows that early treatment of chronic hepatitis B infection can cut deaths and be cost-effective. Health Affairs (Millwood). 2011;30:340–8.CrossRefGoogle ScholarPubMed
20.Veldhuijzen, IK, Toy, M, Hahne, SJ, et al.Screening and early treatment of migrants for chronic hepatitis B virus infection is cost-effective. Gastroenterology. 2010;138:522–30.CrossRefGoogle ScholarPubMed
21.Eckman, MH, Kaiser, TE, Sherman, KE. The cost-effectiveness of screening for chronic hepatitis B infection in the United States. Clin Infect Dis. 2011;52:1294–306.CrossRefGoogle ScholarPubMed
22.Iloeje, UH, Yang, HI, Su, J, et al.Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology. 2006;130:678–86.CrossRefGoogle ScholarPubMed
23.Chen, CJ, Yang, HI, Su, J, et al.Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA. 2006;295:65–73.CrossRefGoogle ScholarPubMed
24.Croagh, CMN, Bell, SJ, Slavin, J, et al.Increasing hepatitis B viral load is associated with risk of significant liver fibrosis in HBeAg-negative but not HBeAg-positive chronic hepatitis B. Liver Int. 2010;30:1115–22.CrossRefGoogle Scholar
25.Kobashi, H, Miyake, Y, Ikeda, F, et al.Long-term outcome and hepatocellular carcinoma development in chronic hepatitis B or cirrhosis patients after nucleoside analog treatment with entecavir or lamivudine. Hepatol Res. 2011;41:405–16.CrossRefGoogle ScholarPubMed