Korean J Hepatol.  2009 Mar;15(1):25-41. 10.3350/kjhep.2009.15.1.25.

Analysis of the cost-effectiveness of antiviral therapies in chronic hepatitis B patients in Korea

• Kim BK
• Kwon SY
• Lee CH
• Choe WH
• Choi HM
• Koo HW

• KMID: 1776812
• DOI: http://doi.org/10.3350/kjhep.2009.15.1.25

Abstract

BACKGROUND/AIMS
The purpose of this study was to evaluate the cost-effectiveness of 1 year and up to 5 years of antiviral treatment for chronic hepatitis B (CHB).
METHODS
Two ten-health-state Markov models were developed for CHB patients. The proportion of patients remaining alive in each health state, and healthcare costs and quality-adjusted life years (QALYs) were determined during annual cycles of these Markov models. The total healthcare costs, life years, and QALYs over the 40-year time horizon of the model were calculated. The perspectives of the cost-effectiveness analysis were the Korean healthcare system and the healthcare needs of the CHB patient.
RESULTS
Short-course therapy with alpha-interferon or 1-year treatment with pegylated interferon alpha-2a, lamivudine (LMV), or adefovir (ADV) had limited impact on disease progression. In contrast, either LMV-ADV or ADV-LMV as rescue medication administered for 5 years resulted in a more sustained decrease in the rate of disease progression. The cost-effectiveness threshold in Korea was estimated to be approximately 25,000,000 South Korean won. LMV administered for 1 year is cost-effective in comparison with no treatment for both HBeAg-positive and HBeAg-negative CHB patients, but longer duration antiviral therapies administered for up to 5 years in CHB patients were found to be highly cost-effective by international standards.
CONCLUSIONS
Antiviral treatment of CHB with LMV or ADV for up to 5 years using the alternative antiviral agent as rescue medication appears to be a cost-effective strategy for both HBeAg-positive and HBeAg-negative CHB patients in Korea. Economic evaluation of antiviral therapies should be studied further and updated, particularly for newer agents.

Keyword

Chronic hepatitis B; Antiviral agents; Treatment outcome; Cost effectiveness

MeSH Terms

Adenine/*analogs & derivatives/economics/therapeutic use
Antiviral Agents/*economics/therapeutic use
Cohort Studies
Cost-Benefit Analysis
Drug Therapy, Combination
Hepatitis B e Antigens/blood
Hepatitis B, Chronic/drug therapy/*economics
Humans
Interferon-alpha/*economics/therapeutic use
Korea
Lamivudine/*economics/therapeutic use
Models, Statistical
Phosphonic Acids/*economics/therapeutic use
Quality of Life
Severity of Illness Index