Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-07T04:45:18.220Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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