Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patients
Chi Zhang,* Weixia Ke,* Li Liu, Yanhui Gao, Zhenjiang Yao, Xiaohua Ye, Shudong Zhou, Yi Yang Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People’s Republic of China *These authors contributed equally to&...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2016-03-01
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| Series: | Drug Design, Development and Therapy |
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| Online Access: | https://www.dovepress.com/cost-effectiveness-comparison-of-lamivudine-plus-adefovir-combination--peer-reviewed-article-DDDT |
| _version_ | 1811191704619843584 |
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| author | Zhang C Ke WX Liu L Gao YH Yao ZJ Ye XH Zhou SD Yang Y |
| author_facet | Zhang C Ke WX Liu L Gao YH Yao ZJ Ye XH Zhou SD Yang Y |
| author_sort | Zhang C |
| collection | DOAJ |
| description | Chi Zhang,* Weixia Ke,* Li Liu, Yanhui Gao, Zhenjiang Yao, Xiaohua Ye, Shudong Zhou, Yi Yang Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People’s Republic of China *These authors contributed equally to this work Background/aim: Lamivudine (LAM) plus adefovir (ADV) combination therapy is clinically efficacious for treating chronic hepatitis B (CHB) patients in China, but no pharmacoeconomic evaluations of this strategy are available. The aim of this study was to examine the cost-effectiveness of LAM plus ADV combination treatment compared with five other nucleos(t)ide analog monotherapies (LAM, ADV, telbivudine [TBV], entecavir [ETV], and tenofovir [TDF]).Methods: To simulate the lifetime (40-year time span) costs and quality-adjusted life-years (QALYs) for different therapy options, a Markov model that included five initial monotherapies and LAM plus ADV combination as an initial treatment was developed. Two kinds of rescue combination strategies (base-case: LAM + ADV then ETV + ADV; alternative: direct use of ETV + ADV) were considered separately for treating patients refractory to initial therapy. One-way and probabilistic sensitivity analyses were used to explore model uncertainties.Results: In base-case analysis, ETV had the lowest lifetime cost and served as the reference therapy. Compared to the reference, LAM, ADV, and TBV had higher costs and lower efficacy, and were completely dominated by ETV. LAM plus ADV combination therapy or TDF was more efficacious than ETV, but also more expensive. Although the incremental cost-effectiveness ratios of combination therapy or TDF were both higher than the willingness-to-pay threshold of $20,466/QALY gained for the reference treatment, in an alternative scenario analysis LAM plus ADV combination therapy would be the preferable treatment option.Conclusion: ETV and LAM plus ADV combination therapy are both cost-effective strategies for treating Chinese CHB patients. Keywords: cost-effectiveness, chronic hepatitis B, nucleos(t)ide analog, combination treatment |
| first_indexed | 2024-04-11T23:40:22Z |
| format | Article |
| id | doaj.art-96e82a0e2b5543e1b5e902a51e841f7d |
| institution | Directory Open Access Journal |
| issn | 1177-8881 |
| language | English |
| last_indexed | 2024-04-11T23:40:22Z |
| publishDate | 2016-03-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Drug Design, Development and Therapy |
| spelling | doaj.art-96e82a0e2b5543e1b5e902a51e841f7d2022-12-22T03:56:48ZengDove Medical PressDrug Design, Development and Therapy1177-88812016-03-012016Issue 189791025803Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patientsZhang CKe WXLiu LGao YHYao ZJYe XHZhou SDYang YChi Zhang,* Weixia Ke,* Li Liu, Yanhui Gao, Zhenjiang Yao, Xiaohua Ye, Shudong Zhou, Yi Yang Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, People’s Republic of China *These authors contributed equally to this work Background/aim: Lamivudine (LAM) plus adefovir (ADV) combination therapy is clinically efficacious for treating chronic hepatitis B (CHB) patients in China, but no pharmacoeconomic evaluations of this strategy are available. The aim of this study was to examine the cost-effectiveness of LAM plus ADV combination treatment compared with five other nucleos(t)ide analog monotherapies (LAM, ADV, telbivudine [TBV], entecavir [ETV], and tenofovir [TDF]).Methods: To simulate the lifetime (40-year time span) costs and quality-adjusted life-years (QALYs) for different therapy options, a Markov model that included five initial monotherapies and LAM plus ADV combination as an initial treatment was developed. Two kinds of rescue combination strategies (base-case: LAM + ADV then ETV + ADV; alternative: direct use of ETV + ADV) were considered separately for treating patients refractory to initial therapy. One-way and probabilistic sensitivity analyses were used to explore model uncertainties.Results: In base-case analysis, ETV had the lowest lifetime cost and served as the reference therapy. Compared to the reference, LAM, ADV, and TBV had higher costs and lower efficacy, and were completely dominated by ETV. LAM plus ADV combination therapy or TDF was more efficacious than ETV, but also more expensive. Although the incremental cost-effectiveness ratios of combination therapy or TDF were both higher than the willingness-to-pay threshold of $20,466/QALY gained for the reference treatment, in an alternative scenario analysis LAM plus ADV combination therapy would be the preferable treatment option.Conclusion: ETV and LAM plus ADV combination therapy are both cost-effective strategies for treating Chinese CHB patients. Keywords: cost-effectiveness, chronic hepatitis B, nucleos(t)ide analog, combination treatmenthttps://www.dovepress.com/cost-effectiveness-comparison-of-lamivudine-plus-adefovir-combination--peer-reviewed-article-DDDTCost-effectivenessChronic hepatitis BNucleos(t)ide analogueCombination treatment |
| spellingShingle | Zhang C Ke WX Liu L Gao YH Yao ZJ Ye XH Zhou SD Yang Y Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patients Drug Design, Development and Therapy Cost-effectiveness Chronic hepatitis B Nucleos(t)ide analogue Combination treatment |
| title | Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patients |
| title_full | Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patients |
| title_fullStr | Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patients |
| title_full_unstemmed | Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patients |
| title_short | Cost-effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos(t)ide analog monotherapies in Chinese chronic hepatitis B patients |
| title_sort | cost effectiveness comparison of lamivudine plus adefovir combination treatment and nucleos t ide analog monotherapies in chinese chronic hepatitis b patients |
| topic | Cost-effectiveness Chronic hepatitis B Nucleos(t)ide analogue Combination treatment |
| url | https://www.dovepress.com/cost-effectiveness-comparison-of-lamivudine-plus-adefovir-combination--peer-reviewed-article-DDDT |
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