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

Predictors of HBsAg seroclearance in patients with chronic HBV infection treated with pegylated interferon-α: a systematic review and meta-analysis

“…Expanding the treatment indications for CHB and increasing the coverage of available treatments are highly effective and cost-effective strategies to reduce adverse outcomes related to CHB [ 38 ]. Combining NAs with PegIFNα and extending the treatment duration in current therapeutic regimens have been shown to prolong quality-adjusted life-years, making it more cost-effective than NAs monotherapy [ 39 ]. Ongoing real-world studies with large sample sizes and multicenter participation are focused on achieving functional cure for CHB patients and reducing the incidence of liver cancer [ 15 , 40 , 41 ].…”

Pegylated interferon‐α‐2b combined with tenofovir disoproxil fumarate, granulocyte‐macrophage colony‐stimulating factor, and hepatitis B vaccine treatment for naïve HBeAg‐positive chronic hepatitis B patients: A prospective, multicenter, randomized controlled study

“…As of date, IFN remains the main drug for the functional cure of hepatitis B. IFN can achieve a higher functional cure rate in treating e‐antigen‐negative CHB or HBsAg in inactive HBsAg carriers. The lower the baseline HBsAg level, the higher is the chance of achieving a functional cure 22,23 . The functional cure rate in patients with e antigen‐positive CHB is still a clinical problem.…”

“…The lower the baseline HBsAg level, the higher is the chance of achieving a functional cure. 22,23 The functional cure rate in patients with e antigen-positive CHB is still a clinical problem. Li et al 24 compared the therapeutic efficacy of three strategies, including TDF monotherapy, peg-IFNα add-on therapy, and de novo combination therapy, in HBeAg-positive naïve patients; the rates of HBsAg seroconversion were still low and not significantly different among the three groups.…”

HBeAg-negative Patients with Chronic Hepatitis B Virus Infection and Normal Alanine Aminotransferase: Wait or Treat?

“…The treat-IT strategy was preferred to the untreat-IT strategy when the annual HCC incidence was higher than 0.54% based in a cost-effectiveness threshold of USA$20,000/QALY from a healthcare system perspective. 35 In a Chinese population, Chen et al 36 reported that combination therapy with NAs and PEG-IFN-α for HBeAg-negative patients with HBsAg ≤1,000 IU/mL not only increased the QALYs, but also reduced medical costs and was more cost-effective than NAs monotherapy.…”

“… 35 In a Chinese population, Chen et al . 36 reported that combination therapy with NAs and PEG-IFN-α for HBeAg-negative patients with HBsAg ≤1,000 IU/mL not only increased the QALYs, but also reduced medical costs and was more cost-effective than NAs monotherapy.…”