Custo-utilidade do tenofovir comparado com entecavir no tratamento em primeira linha da hepatite B crónica

Abstract

IntroductionTenofovir and entecavir are the two recommended first-line oral antiviral therapies for treatment of chronic hepatitis B. GoalTo estimate the cost-effectiveness of the two alternatives in adult patients with active chronic hepatitis B. MethodsA Markov model, conditional on HBeAg positivity/negativity, was built on two dimensions: disease stage and therapeutic line. Efficacy data reported in clinical trials was measured in quality adjusted life years. Costs were obtained using the modified Delphi panel method. A lifetime time horizon and a 5% annual discount rate were assumed. ResultsTenofovir, when compared to entecavir as a first-line antiviral oral therapy, results in a 20% decrease in the number of therapy failures. With tenofovir, the rate of new cirrhoses cases, hepatocellular carcinoma and liver transplants, is also lower. Tenofovir when compared to entecavir, results in a lifetime total average discounted (undiscounted) cost saving of 11,865€ (23,046€) and a 0.04 increment in quality adjusted life years. As such, tenofovir is a dominant strategy when compared to entecavir. ConclusionsIn the analysis and when clinically viable, tenofovir is a more effective and less costly strategy for initial oral antiviral treatment of CHB when compared to entecavir.