Abstract
BackgroundOnly lamivudine has been included for patients with chronic hepatitis B (CHB) in the National List of Essential Drugs (NLED), a pharmaceutical reimbursement list in Thailand. There have also been no economic evaluation studies of CHB drug treatments conducted in Thailand yet. In order to fill this gap in policy research, the objective of this study was to compare the cost-utility of each drug therapy (Figure 1) with palliative care in patients with HBeAg-positive CHB.MethodsA cost-utility analysis using an economic evaluation model was performed to compare each drug treatment for HBeAg-positive CHB patients. A Markov model was used to estimate the relevant costs and health outcomes during a lifetime horizon based on a societal perspective. Direct medical costs, direct non-medical costs, and indirect costs were included, and health outcomes were denoted in life years (LYs) and quality-adjusted life years (QALYs). The results were presented as an incremental cost effectiveness ratio (ICER) in Thai baht (THB) per LY or QALY gained. One-way sensitivity and probabilistic sensitivity analyses were applied to investigate the effects of model parameter uncertainties.ResultsThe ICER values of providing generic lamivudine with the addition of tenofovir when drug resistance occurred, generic lamivudine with the addition of tenofovir based on the road map guideline, and tenofovir monotherapy were -14,000 (USD -467), -8,000 (USD -267) , and -5,000 (USD -167) THB per QALY gained, respectively. However, when taking into account all parameter uncertainties in the model, providing generic lamivudine with the addition of tenofovir when drug resistance occurred (78% and 75%) and tenofovir monotherapy (18% and 24%) would yield higher probabilities of being cost-effective at the societal willingness to pay thresholds of 100,000 (USD 3,333) and 300,000 (USD 10,000) THB per QALY gained in Thailand, respectively.ConclusionsBased on the policy recommendations from this study, the Thai government decided to include tenofovir into the NLED in addition to generic lamivudine which is already on the list. Moreover, the results have shown that the preferred treatment regimen involves using generic lamivudine as the first-line drug with tenofovir added if drug resistance occurs in HBeAg-positive CHB patients.
Highlights
Lamivudine has been included for patients with chronic hepatitis B (CHB) in the National List of Essential Drugs (NLED), a pharmaceutical reimbursement list in Thailand
The important parameters of the most cost-saving intervention were selected. The outcome of this analysis showed which parameters the incremental cost effectiveness ratio (ICER) per quality-adjusted life years (QALYs) gained were most sensitive to when altering the values, and they are listed as follows from most to least sensitive: the cost of treatment of compensated cirrhosis; the price of tenofovir; the price of lamivudine; the cost of treatment of decompensated cirrhosis; the cost of treatment of hepatocellular carcinoma (HCC); the discount rates of 0% and 6% per annum for cost and outcome; the relative risk of seroconversion of lamivudine; and the probability of transitioning from a CHB state to the death state
When considering the provision of CHB treatment to HBeAgpositive CHB patients above 30 years of age (i.e., 40-70 years), providing generic lamivudine plus tenofovir when drug resistance occurred and tenofovir monotherapy were dominant and cost-saving interventions compared with palliative care
Summary
Lamivudine has been included for patients with chronic hepatitis B (CHB) in the National List of Essential Drugs (NLED), a pharmaceutical reimbursement list in Thailand. There have been no economic evaluation studies of CHB drug treatments conducted in Thailand yet. The goal of drug treatments for chronic hepatitis B (CHB) is to improve quality of life and survival by preventing the disease from developing into cirrhosis, decompensated cirrhosis, end-stage liver disease, HCC, and death by reducing viral replication to the lowest possible level and maintaining it over the long-term. Tenofovir – an approved drug for the treatment of HIV but not CHB – is currently being prescribed to CHB patients in 300 mg daily doses due to its high viral efficacy and low resistance rates [3,4]
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