Cost-effectiveness of combination antiviral treatment with extended duration for hepatitis B e antigen (HBeAg)-negative chronic hepatitis B in China

Runqin Li; Xiao Lin; Jing-Yue Wang; Xiaomo Wang; Junfeng Lu; Yali Liu; Zhenhuan Cao; Shan Ren; Lina Ma; Yi Jin; Sujun Zheng; Zhongjie Hu; Li Wang; Xinyue Chen

doi:10.21037/atm-21-1666

Cost-effectiveness of combination antiviral treatment with extended duration for hepatitis B e antigen (HBeAg)-negative chronic hepatitis B in China

Ann Transl Med. 2021 Sep;9(17):1365. doi: 10.21037/atm-21-1666.

Authors

Runqin Li¹, Xiao Lin¹, Jing-Yue Wang², Xiaomo Wang³, Junfeng Lu¹, Yali Liu⁴, Zhenhuan Cao¹, Shan Ren¹, Lina Ma¹, Yi Jin¹, Sujun Zheng¹, Zhongjie Hu¹, Li Wang³, Xinyue Chen¹

Affiliations

¹ The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
² Division of Hepatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
³ Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
⁴ The Third Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Hepatitis B surface antigen clearance or seroconversion is rarely achieved for patients using nucleoside analogs or pegylated interferon alpha monotherapy approaches. Several recent studies have confirmed the benefit of a combination of these two approaches for selected chronic hepatitis B patients. However, few reports have investigated long-term outcomes or health economic evaluation for hepatitis B surface antigen clearance. The aim of this study was to perform a cost-effectiveness analysis of the long-term use of this combination strategy among selected hepatitis B e antigen-negative patients.

Methods: Drawing on experience in China, we used a Markov model to simulate disease progression among a population of hepatitis B e antigen-negative chronic hepatitis B patients with surface antigen levels of ≤1,000 IU/mL through a discrete series of health states. We compared nucleoside analog monotherapy to the combination strategy over a prolonged period. We measured lifetime costs, quality-adjusted life-years and incremental cost-effectiveness ratios.

Results: The combination therapy produced 15.8 quality-adjusted life-years, and cost US dollars (USD) 45,032 per patient. The monotherapy gave 13.9 quality-adjusted life-years, and had a cost of USD 52,064. The incremental cost-effectiveness ratio of the monotherapy (USD -3,755 per quality-adjusted life-year) did not obtain extended dominance over combination therapy. The most cost-effective option was combination therapy among patients with hepatitis B surface antigen levels of ≤10 IU/mL, which had the lowest calculated cost of USD 35,318 and most quality-adjusted life-years (16.7).

Conclusions: A long-term combination treatment strategy for selected hepatitis B e antigen-negative chronic hepatitis B patients may prolong quality-adjusted life-years compared with nucleoside analog monotherapy. Chronic hepatitis B patients with a hepatitis B surface antigen level of ≤10 IU/mL were the most cost-effective population under this strategy.

Keywords: Cost-effectiveness; chronic hepatitis B; functional cure; hepatitis B surface antigen loss (HBsAg loss); quality-adjusted life-years (QALYs).