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Original article

Cost-effectiveness analysis of roadmap models in chronic hepatitis B using tenofovir as the rescue therapy

Yanni Yan-Ni Lui, Kelvin Kam-Fai Tsoi, Vincent Wai-Sun Wong, Jia-Horng Kao, Jin-Lin Hou, Eng-Kiong Teo, Rosmawati Mohamed, Teerha Piratvisuth, Kwang-Hyub Han, Ulrike Mihm, Grace Lai-Hung Wong, Henry Lik-Yuen Chan

Corresponding author name: Henry Lik-Yuen Chan
Corresponding author e-mail: hlychan@cuhk.edu.hk

Citation: Antiviral Therapy 2010; 15:145-155
doi: 10.3851/IMP1496

Date accepted: 21 September 2009
Date published online: 23 February 2010

Abstract

Background: The roadmap approach is recommended to guide chronic hepatitis B treatment. We evaluated the cost-effectiveness of various treatment strategies in the global market.

Methods: Lamivudine and telbivudine were tested in roadmap models with switch-to tenofovir if HBV was detectable at week 24 or add-on tenofovir if resistance developed at year 1. Tenofovir and entecavir were tested as continuous monotherapy. In the reference arm, lamivudine was used with add-on tenofovir if resistance developed at year 1. The primary measure of effectiveness was undetectable HBV DNA at year 2. Cost-effectiveness was measured by incremental cost-effectiveness ratio (ICER) in US dollars against the reference arm.

Results: In the US and Germany, costs of the reference arms were US $14,486 and US $9,998 for hepatitis B e antigen (HBeAg)-positive and US $11,398 and US $7,531 for HBeAg-negative patients, respectively. In HBeAg-positive patients, the lamivudine roadmap was most cost-effective (ICER US $15,260 in the US and US $29,113 in Germany) with comparable effectiveness (75.1%) to other strategies. In HBeAg-negative patients, tenofovir and entecavir monotherapies were most effective (91–96%) and cost-effective (ICER US $31,297–43,387 in the US and US $53,976–59,822 in Germany). In Asia, where telbivudine cost was lower, both telbivudine and lamivudine roadmaps were cost-effective in HBeAg-positive patients. Tenofovir would be most cost-effective in HBeAg-negative patients if its cost equaled that of telbivudine in Asia.

Conclusions: In HBeAg-positive patients, lamivudine roadmap was most cost-effective; in Asia, telbivudine roadmap had comparable cost-effectiveness to lamivudine roadmap because of the relatively low price of telbivudine. In HBeAg-negative patients, entecavir and tenofovir monotherapies were more cost-effective than the roadmap models.

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