522] COST-EFFECTIVENESS OF TELBIVUDINE VERSUS LAMIVUDINE FOR CHRONIC HEPATITIS B

Abstract

Aim: To estimate the cost-effectiveness of telbivudine versus lamivudine for HBeAg-positive or negative chronic hepatitis B. Methods: Individual patient data (age, gender, virological, serological and biochemical response and resistance to telbivudine versus lamivudine) after I04 weeks from the multinational GLOBE registration trial (n = 1367) were applied to a Markov cohort simulation to project lifelong clinical and economic outcomes using US data for life expectancy, quality of life, liver transplant survival, drug costs (telbivudine $1 8 and lamivudine $7 per pill) with a 3% annual discount rate. Because of differences in demographic characteristics and response, separate analyses were performed for HBeAgpositive and negative patients. Results: At week 104, non-detectable HBV DNA responses occurred in 56% with telbivudine and 38% with lamivudine of HBeAg-positive patients (p <0.0001), and in 82% with telbivudine and 57% with lamivudine of HBeAg-negative patients (p < 0.000 I ) . For HBeAg-positive patients, telbivudine reduced the 10-year relative risk of cirrhosis by 33% (from 14% to 9.6%) and extended life by 3.8 years (4.3 quality-adjusted life years) in the model. Telbivudine had an incremental cost-effectiveness ratio of $2,500 per discounted quality-adjusted life year (DQALY) gained. Because disease progression is more rapid in older patients and in men, incremental cost-effectiveness ratios for telbivudine were $5,000 at age 20, $2,800 at age 30, $2,200 at age 40 and $2,700 at age 50 (baseline 74.3% men) and were $1,600 for men and $6,900 for women (baseline mean age 32.4). For HBeAg-negative patients, telbivudine reduced the 1 0-year relative risk of cirrhosis by 18% (from 12% to 9.9%) and extended life by 0.8 years (0.8 quality-adjusted life years). Telbivudine had an incremental cost-effectiveness ratio of $37,800 per DQALY. In sensitivity analysis, incremental cost-effectiveness ratios for telbivudine were $59,000 at age 20, $48,900 at age 30, $40,100 at age 40, $33,000 at age 50 (baseline 78.9% men) and were $34,300 for men and $54,200 for women (baseline mean age 42.9). Conclusions: Based on the 104-week GLOBE trial results for patients with chronic hepatitis B, telbivudine may prolong life and should be a cost-effective alternative to lamivudine with an incremental cost-utility ratio falling within the range of other accepted medical interventions.