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

作者：Yanni Yan-Ni Lui, Kelvin 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 · 发表于：Antiviral Therapy · 年份：2009 · DOI：10.3851/imp1496 · 被引用次数：41 · 研究领域：Hepatitis B Virus Studies、Hepatitis C virus research、HIV/AIDS drug development and treatment

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 eq...