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Cost-effectiveness of nucleoside analog therapy for hepatitis B in China: a Markov analysis
- Source :
- Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 13(5)
- Publication Year :
- 2010
-
Abstract
- Objectives The aim of this study was to investigate the economic consequences of nucleoside analog therapy for hepatitis B treatment in China. Methods A cost-utility analysis of treatments for HBeAg-positive and HBeAg-negative chronic hepatitis B (CHB) was conducted using a Markov model, in which patients' yearly transitions between different health states were tracked. Patients were tracked as they moved between the following health states: CHB, HBeAg seroconversion (HBeAg-positive CHB patients can have this special health state), virologic resistance, virologic response, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation, and death. The transition parameters were derived either from systematic reviews of the literature or from previous economic studies. Cost and utility data came from studies based on a Chinese CHB cohort. One-way sensitivity analyses as well as second-order Monte Carlo and probabilistic sensitivity analyses were performed. Results The entecavir strategy yielded the most quality-adjusted life years (QALYs) for both HBeAg-positive and HBeAg-negative patients when compared with the "no treatment," the lamivudine, the adefovir, and the telbivudine strategies. The risks of complications and mortality also decreased. In the economic analysis, the "no treatment" strategy was the least effective, whereas the entecavir strategy was both the least expensive and the most cost-effective option, followed by telbivudine and lamivudine. The probabilistic sensitivity analysis showed that the entecavir strategy would result in improved cost-effectiveness in >90% of cases at a threshold of $20,000 per QALY. In a one-way sensitivity analysis, the most influential parameters impacting the model's robustness were the utilities of the CHB and virologic response health states. Conclusions In China, when treating both HBeAg-positive and HBeAg-negative CHB populations, entecavir is the most cost-effective option when compared with lamivudine, adefovir, and telbivudine.
- Subjects :
- medicine.medical_specialty
Pediatrics
China
Guanine
Cost effectiveness
Cost-Benefit Analysis
Organophosphonates
Pyrimidinones
Antiviral Agents
Hepatitis B, Chronic
Telbivudine
Adefovir
medicine
Humans
chronic hepatitis B
Serologic Tests
Hepatitis B e Antigens
nucleoside analogs
cost-effectiveness
Hepatitis B in China
Models, Statistical
business.industry
Health Policy
Adenine
Public Health, Environmental and Occupational Health
virus diseases
Lamivudine
Nucleosides
Entecavir
Hepatitis B
medicine.disease
digestive system diseases
Markov Chains
Surgery
Quality-adjusted life year
Models, Economic
Reverse Transcriptase Inhibitors
Quality-Adjusted Life Years
business
Monte Carlo Method
medicine.drug
Thymidine
Subjects
Details
- ISSN :
- 15244733
- Volume :
- 13
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
- Accession number :
- edsair.doi.dedup.....ef06b9e23326fbde7ee7ec4b538526db