A Novel Estimation of the Relative Economic Value in Terms of Different Chronic Hepatitis B Treatment Options

초록

Background: Prescribers, payors and healthcare decision-makers are increasingly examining the value of treatments. This study aims at analyzing economic value of chronic hepatitis B (CHB) treatment options, which are available in Korea. Methods: CHB infection was simulated using a health-state transition model with disease states defined as mild disease (Ishak F0/F1), fibrosis (F2/F3/F4), advanced fibrosis/cirrhosis (> F4), and complicated disease states (decompensated cirrhosis, hepatocellular carcinoma, liver transplant and death) based on available natural history data. The value of treatment-specific attributes on disease progression/regression was estimated based on published data in terms of events and costs avoided. 5-year treatment duration was assumed except for treatment initiation. Primary model output is the estimated cost savings of entecavir per patient per day of treatment versus the comparator in question for a given CHB patient. Results: The simulation of treating with entecavir versus no treatment predicted improved clinical outcomes for entecavir-treatment patients. In the long term, these clinical benefits translate into cost savings of $3.10perdayoftreatment.Innaivepatienttreatment,dailycostsavingsofusingentecavirversuslamivudineortelbivudinewasestimatedat$2.89 and $1.72,respectively.Inthecaseofsuboptimalresponderswhopre-treatedwithlamivudine,dailycostsavingforpatientsswitchingtoentecavirwas$1.38 per day of treatment compared to patients maintaining on lamivudine. Conclusions: Entecavir exhibits characteristics of a favourable CHB treatment, which directly translates into economic and therapeutic value as opposed to either no treatment or alternative strategies.

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