Abstract
Chronic liver disease and liver cancer associated with chronic hepatitis B (CHB) are leading causes of death among adults in China. Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, about 100 million Chinese adults remain chronically infected. If left unmanaged, 15–25% will die from liver cancer or liver cirrhosis. Antiviral treatment is not necessary for all patients with CHB, but when it is indicated, good response to treatment would prevent disease progression and reduce disease mortality and morbidity, and costly complications. The aim of this study is to analyze the cost-effectiveness of generic and brand antiviral drugs for CHB treatment in China, and assessing various thresholds at which a highly potent, low resistance antiviral drug would be cost-saving and/or cost-effective to introduce in a national treatment program. We developed a Markov simulation model of disease progression using effectiveness and cost data from the medical literature. We measured life-time costs, quality adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and clinical outcomes. The no treatment strategy incurred the highest health care costs ($12,932-$25,293) per patient, and the worst health outcomes, compared to the antiviral treatment strategies. Monotherapy with either entecavir or tenofovir yielded the most QALYs (14.10–19.02) for both HBeAg-positive and negative patients, with or without cirrhosis. Threshold analysis showed entercavir or tenofovir treatment would be cost saving if the drug price is $32–75 (195–460 RMB) per month, highly cost-effective at $62–110 (379–670 RMB) per month and cost-effective at $63–120 (384–734 RMB) per month. This study can support policy decisions regarding the implementation of a national health program for chronic hepatitis B treatment in China at the population level.
Highlights
China has the greatest disease burden of chronic hepatitis B (CHB) in the world, with an estimated 350,000–500,000 deaths each year from hepatitis B virus (HBV) related diseases, including hepatocellular carcinoma (HCC) and hepatic failure [1]
Hepatitis B vaccination clearly contributed to the reduction of new cases, it does not address the healthcare needs of the chronically-infected individuals who are at risk of disease progression leading to the development of HCC and cirrhosis
Patients can progress to compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and would be eligible to receive a liver transplantation
Summary
China has the greatest disease burden of chronic hepatitis B (CHB) in the world, with an estimated 350,000–500,000 deaths each year from hepatitis B virus (HBV) related diseases, including hepatocellular carcinoma (HCC) and hepatic failure [1]. 80% of HCC, the most common type of liver cancer, is due to chronic HBV infection in China [2, 3]. Without monitoring or appropriate treatment, 15–25% of those chronically infected will die from liver cancer or liver cirrhosis. Major progress has been made in China to reduce the prevalence of chronic hepatitis B in children through a robust new born immunization program, and a recent nationwide catch up vaccination program for unprotected children [4, 5]. Hepatitis B vaccination clearly contributed to the reduction of new cases, it does not address the healthcare needs of the chronically-infected individuals who are at risk of disease progression leading to the development of HCC and cirrhosis. There is currently no curative treatment for CHB, but good response to approved treatments could prevent disease progression and reduce deaths and costly complications
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