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SHOULD CHRONIC HEPATITIS B BE TREATED AS EARLY AS POSSIBLE?

Published online by Cambridge University Press:  08 January 2013

Frank Hulstaert ,
Christoph Schwierz ,
Frederik Nevens ,
Nancy Thiry ,
Mohamed Gamil ,
Isabelle Colle ,
Stefaan Van de Sande  and
Yves Horsmans
Frank Hulstaert
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Christoph Schwierz
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Frederik Nevens
Affiliation:
Hepatology, UZ Gasthuisberg, KU Leuven
Nancy Thiry
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Mohamed Gamil
Affiliation:
Hepatology, UZ Gasthuisberg, KU Leuven
Isabelle Colle
Affiliation:
Hepatology, University Hospital Ghent
Stefaan Van de Sande
Affiliation:
Belgian Health Care Knowledge Centre (KCE)
Yves Horsmans
Affiliation:
Hepatology, University Hospital Saint-Luc, Brussels
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Abstract

Objectives: We studied the cost-effectiveness of tenofovir and entecavir in e antigen positive (CHBe+) and negative (CHBe-) chronic hepatitis B.

Methods: Using a multicenter survey including 544 patients we measured patient quality of life and attributable costs by clinical disease stage. Natural disease progression was studied in 278 patients in a single center. A Markov model was constructed to follow hypothetical cohorts of treated and untreated 40-year-old CHBe+ and CHBe- patients and 50-year-old patients with compensated cirrhosis.

Results: We did not find an improvement in quality of life when viral load was reduced under treatment. Transition rates to liver cirrhosis were found to be age-dependent. Assuming equal effectiveness, tenofovir dominates the entecavir strategy because of its lower price in Belgium. The incremental cost-effectiveness ratio (ICER) of tenofovir after 20 years is more favorable for treating Caucasian cirrhotic patients (mean ICER €29,000/quality-adjusted life-year [QALY]) compared with treating non-cirrhotic patients (mean ICER €110,000 and 131,000/QALY for CHB e+ and e-, respectively). Within the non-cirrhotic patients the ICER decreases with increasing cohort starting age from 30 to 50 years.

Conclusions: Results of long-term models for tenofovir or entecavir treatment of CHB need to be interpreted with caution as long-term trials with hard end points are lacking. Especially the effect on HCC remains highly uncertain. Based on cost-effectiveness considerations such antiviral treatment should be targeted at patients with cirrhosis or at risk of rapid progression to this disease stage.

Keywords

Chronic hepatitis BAntiviral treatmentTenofovirEntecavirCost-effectiveness analysisCost-utility analysisQuality of lifeNatural disease progression
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 1 , January 2013 , pp. 35 - 41
Copyright
Copyright © Cambridge University Press 2013

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