A cost utility and cost effectiveness analysis of different oral antiviral medications in patients with HBeAg-Negative chronic hepatitis B in Iran: an economic microsimulation decision model

Keshavarz, K., Kebriaeezadeh, A., Alavian, S. M., Sari, A. A., Rezaei Hemami, M., Lotfi, F., Meshkini, A. H., Javanbakht, M., Keshvari, M. and Nikfar, S. (2016) A cost utility and cost effectiveness analysis of different oral antiviral medications in patients with HBeAg-Negative chronic hepatitis B in Iran: an economic microsimulation decision model. Hepatitas Monthly, 16(9), e37435. (doi: 10.5812/hepatmon.37435)

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Abstract

Background: Although hepatitis B infection is the major cause of chronic liver disease in Iran, no studies have employed economic evaluations of the medications used to treat Iranian patients with chronic hepatitis B (CHB). Therefore, the cost-effectiveness of the different treatment options for this disease in Iran is unknown. Objectives: The aim of this study was to compare the cost utility and cost-effectiveness of medication strategies tailored to local conditions in patients with HB e antigen (HBeAg)-negative CHB infection in Iran. Methods: An economic evaluation of the cost utility of the following five oral medication strategies was conducted: adefovir (ADV), lamivudine (LAM), ADV + LAM, entecavir (ETV), and tenofovir (TDF). A Markov microsimulation model was used to estimate the clinical and economic outcomes over the course of the patient’s lifetime and based on a societal perspective. Medical and nonmedical direct costs and indirect costs were included in the study and life-years gained (LYG) and quality-adjusted life-years (QALY) were determined as measures of effectiveness. The results are presented in terms of the incremental cost-effectiveness ratio (ICER) per QALY or LYG. The model consisted of nine stages of the disease. The transition probabilities for the movement between the different stages were based on clinical evidence and international expert opinion. A probabilistic sensitivity analysis (PSA) was used to measure the effects of uncertainty in the model parameters. Results: The results revealed that the TDF treatment strategy was more effective and less costly than the other options. In addition, TDF had the highest QALY and LYG in the HBeAg-negative CHB patients, with 13.58 and 21.26 (discounted) in all comparisons. The PSA proved the robustness of the model results. The cost-effectiveness acceptability curves showed that TDF was the most cost-effective treatment in 59% - 78% of the simulations of HBeAg-negative patients, with WTP thresholds less than $14010 (maximum WTP per QALY). Conclusions: The use of TDF in patients with HBeAg-negative CHB seemed to be a highly cost-effective strategy. Compared with the other available medication options, TDF was the most cost-saving strategy. Thus, TDF may be the best option as a first-line medication. Patients can also be switched from other medications to TDF.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Rezaeihemami, Dr Mohsen
Authors: Keshavarz, K., Kebriaeezadeh, A., Alavian, S. M., Sari, A. A., Rezaei Hemami, M., Lotfi, F., Meshkini, A. H., Javanbakht, M., Keshvari, M., and Nikfar, S.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
Journal Name:Hepatitas Monthly
Publisher:Kowsar Corporation
ISSN:1735-143X
ISSN (Online):1735-3408
Published Online:14 August 2016
Copyright Holders:Copyright © 2016 Kowsar Corp.
First Published:First published in Hepatitas Monthly 16(9): e37435
Publisher Policy:Reproduced under a Creative Commons License

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