Cost-effectiveness of entecavir versus lamivudine for the suppression of viral replication in chronic hepatitis B Patients in Brazil

Costa, Anna-Maria; L.'Italien, Gilbert; Nita, Marcelo Eidi; Araújo, Evaldo Stanislau Affonso de

doi:10.1590/s1413-86702008000500005

Cited by 16 publications

(13 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The national health status in Yemen has been in steady growth recently due to the concerted efforts to educate the public about the importance of immunization in the fight against infectious childhood diseases in minimizing mortality rate. However, our study showed lower coverage compared to endemic developed [25] and developing [26] countries, where HBV vaccine coverage rates among children ranged from 90 to 98%.…”

Section: Discussioncontrasting

confidence: 63%

Assessment of Immunization to Hepatitis B Vaccine among Children under Five Years in Rural Areas of Taiz, Yemen

Alssamei

Al-Sonboli

Alkumaim³

et al. 2017

Hepatitis Research and Treatment

View full text Add to dashboard Cite

Background. Hepatitis B virus (HBV) infection poses a major health problem worldwide. approximately 1 million deaths annually due to cirrhosis and hepatocellular carcinoma. Objectives. This study was conducted to determine the coverage rate of HBV vaccine and assess the vaccine protective response among children under five years old in rural areas of Yemen. Methods. A cross-sectional study was conducted from January to December 2015 in four districts of countryside Yemen. The target population was children aged from 6 to 59 months. 227 children were enrolled in the study. Questionnaire was used to collect of data. Serum samples were tested for anti-HBs antibodies by enzyme linked immunosorbent assay (ELISA). Anti-HBs level ≥ 10 IU/L was considered a protective response to the vaccine. Results. The coverage rate of HBV vaccine among children was 87.3%. A total of 143 (72.2%) children responded to the vaccine with anti-HBs level ≥ 10 IU/L, while 55 (27.8%) of the children had nonprotective anti-HBs levels of <10 IU/L (P = 0.003). Conclusion. This study revealed a good coverage rate of HBV vaccine in rural areas but the protective rate against HBV infection was moderate. A considerable proportion of vaccinated children should be considered for either revaccination or booster doses.

show abstract

Section: Discussioncontrasting

confidence: 63%

Assessment of Immunization to Hepatitis B Vaccine among Children under Five Years in Rural Areas of Taiz, Yemen

Alssamei

Al-Sonboli

Alkumaim³

et al. 2017

Hepatitis Research and Treatment

View full text Add to dashboard Cite

show abstract

“…In addition, most studies performed in the US [8-14], Australia [15], and Asia [16,17] demonstrated that entecavir was superior when compared with lamivudine. Another study by Buti et al showed that tenofovir was the better cost-effective treatment when compared with entecavir, telvibudine, and adefovir [13].…”

Section: Introductionmentioning

confidence: 99%

A cost-utility analysis of drug treatments in patients with HBeAg-positive chronic hepatitis B in Thailand

Tantai

Chaikledkaew

Tanwandee

et al. 2014

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundOnly lamivudine has been included for patients with chronic hepatitis B (CHB) in the National List of Essential Drugs (NLED), a pharmaceutical reimbursement list in Thailand. There have also been no economic evaluation studies of CHB drug treatments conducted in Thailand yet. In order to fill this gap in policy research, the objective of this study was to compare the cost-utility of each drug therapy (Figure 1) with palliative care in patients with HBeAg-positive CHB.MethodsA cost-utility analysis using an economic evaluation model was performed to compare each drug treatment for HBeAg-positive CHB patients. A Markov model was used to estimate the relevant costs and health outcomes during a lifetime horizon based on a societal perspective. Direct medical costs, direct non-medical costs, and indirect costs were included, and health outcomes were denoted in life years (LYs) and quality-adjusted life years (QALYs). The results were presented as an incremental cost effectiveness ratio (ICER) in Thai baht (THB) per LY or QALY gained. One-way sensitivity and probabilistic sensitivity analyses were applied to investigate the effects of model parameter uncertainties.ResultsThe ICER values of providing generic lamivudine with the addition of tenofovir when drug resistance occurred, generic lamivudine with the addition of tenofovir based on the road map guideline, and tenofovir monotherapy were -14,000 (USD -467), -8,000 (USD -267) , and -5,000 (USD -167) THB per QALY gained, respectively. However, when taking into account all parameter uncertainties in the model, providing generic lamivudine with the addition of tenofovir when drug resistance occurred (78% and 75%) and tenofovir monotherapy (18% and 24%) would yield higher probabilities of being cost-effective at the societal willingness to pay thresholds of 100,000 (USD 3,333) and 300,000 (USD 10,000) THB per QALY gained in Thailand, respectively.ConclusionsBased on the policy recommendations from this study, the Thai government decided to include tenofovir into the NLED in addition to generic lamivudine which is already on the list. Moreover, the results have shown that the preferred treatment regimen involves using generic lamivudine as the first-line drug with tenofovir added if drug resistance occurs in HBeAg-positive CHB patients.

show abstract

“…Even taking into account the differences between the studies, the results of the sensitivity analysis were consistent with the observations of the literature for HBeAg positive and negative patients. 3,7,23 Adherence to the treatment, the natural history of the disease, failure to use rates of natural mortality apart from the use of estimates obtained from the literature and the extrapolation of the rates for rescue therapy are all limitations of this study. Low levels of adhesion to the treatment may reduce patients' response to it, compromising its effectiveness against the progression of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…25 Costa et al undertook a study with a ten-year-timeframe comparing entecavir with lamivudine in HBeAg positive and negative patients. 7 Those who developed resistance to lamivudine had adefovir added to their treatment. The study used the following three parameters to judge the treatment's success: percentage of patients who attained undetectable levels of viral load, YAL and the quality of life adjusted to those years gained (QALY).…”

Section: Discussionmentioning

confidence: 99%

Custo-efetividade dos análogos de nucleosídeos/nucleotídeos para hepatite crônica B

et al. 2012

View full text Add to dashboard Cite

OBJECTIVE:To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB). METHODS:Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg-negative) with a 40-year time horizon. Costs and benefi ts were discounted at 5%. Annual rates of disease progression, costs due to complications and the effi cacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties. RESULTS:Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$ 16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine. CONCLUSIONS:The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection. Cost-effectiveness: chronic hepatitis B Almeida AM et al Chronic hepatitis B (CHB) is a serious public health problem which affects between 350 and 400 million people worldwide. 2 A population based prevalence study of hepatitis B infection in Brazil revealed endemic levels > 1% across all the capital cities of each region and of the Federal District. The overall prevalence of HbsAg in the Brazilian state capitals was 0.37% (95%CI 0.25;0.50). The prevalence of this marker was 0.055% (95%CI 0.012;0.10) in the ten to 19 year old age group and of 0.6% (95%CI 0.41;0.78) for the 20 to 69 year old age group. The North showed the highest results for both age groups. a Treatment, when prescribed, is critical in avoiding progression and complications of the disease such as compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma. a Treatment costs become signifi cantly higher with the high morbidity and mortality of patients in advanced stages of the disease, as serious hepatic complications increase the complexity of treatment and the risk of death. 23 In Brazil, until 2009, the guidelines from advocated interferon and lamivudine for the treatment of CHB. Currently, drugs such as adefovir, entecavir and tenofovir are also included. b A systematic review 1 showed adefovir, entecavir and telbivudina effectiveness to be similar to or grea...

show abstract

Cost-effectiveness of entecavir versus lamivudine for the suppression of viral replication in chronic hepatitis B Patients in Brazil

Cited by 16 publications

References 18 publications

Assessment of Immunization to Hepatitis B Vaccine among Children under Five Years in Rural Areas of Taiz, Yemen

Assessment of Immunization to Hepatitis B Vaccine among Children under Five Years in Rural Areas of Taiz, Yemen

A cost-utility analysis of drug treatments in patients with HBeAg-positive chronic hepatitis B in Thailand

Custo-efetividade dos análogos de nucleosídeos/nucleotídeos para hepatite crônica B

Contact Info

Product

Resources

About