Cost–Utility Analysis of Tenofovir Disoproxil Fumarate in the Treatment of Chronic Hepatitis B

Dakin, Helen; Bentley, Anthony; Dusheiko, G.

doi:10.1111/j.1524-4733.2010.00782.x

Cited by 39 publications

(64 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The progression from compensated cirrhosis to decompensated cirrhosis was the same for both studies, as Dakin et al 372 used a synthesis of the same papers 396,398,399 used by Shepherd et al…”

Section: Natural History: Baseline Transition Probabilities Used In Mmentioning

confidence: 92%

“…As the paper by Wong et al 393 was published in 1995, we conducted a search for recently published studies which had cited this paper. This search located a 2010 paper by Dakin et al,372 which assessed the cost-effectiveness of various drug treatments for HBV.…”

Section: Natural History: Baseline Transition Probabilities Used In Mmentioning

confidence: 99%

“…The 2010 paper by Dakin et al 372 sourced transition probability data from natural history studies, economic evaluations or the placebo arms of meta-analyses or RCTs.…”

Section: Natural History: Baseline Transition Probabilities Used In Mmentioning

confidence: 99%

“…As none of the papers located from the updated literature search was relevant, we reviewed the studies which informed the transition probabilities in the model constructed by Shepherd et al 372,376,[392][393][394][395][396][397][398][399][400][401] Some of the papers referenced by Shepherd et al 371 were older published papers. 393,394 Others were published for other aetiologies of liver disease 395 and other models did not provide separate transition probabilities for the mild and moderate health states.…”

Section: Natural History: Baseline Transition Probabilities Used In Mmentioning

confidence: 99%

“…371,372 Fibrosis and cirrhosis health states were defined in the Markov model according to METAVIR score: mild fibrosis (F0-1), moderate fibrosis (F2-3) and compensated cirrhosis (F4). There were five other potential health states in the Markov model: decompensated cirrhosis, hepatocellular cancer (HCC), liver transplant, post liver transplant and a health state representing 'death', which the cohort could enter from all other health states at any time.…”

Section: Markov Model Structurementioning

confidence: 99%

See 4 more Smart Citations

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Crossan

Tsochatzis

Longworth

et al. 2015

Health Technology Assessment

143

190

View full text Add to dashboard Cite

BackgroundLiver biopsy is the reference standard for diagnosing the extent of fibrosis in chronic liver disease; however, it is invasive, with the potential for serious complications. Alternatives to biopsy include non-invasive liver tests (NILTs); however, the cost-effectiveness of these needs to be established.ObjectiveTo assess the diagnostic accuracy and cost-effectiveness of NILTs in patients with chronic liver disease.Data sourcesWe searched various databases from 1998 to April 2012, recent conference proceedings and reference lists.MethodsWe included studies that assessed the diagnostic accuracy of NILTs using liver biopsy as the reference standard. Diagnostic studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-analysis was conducted using the bivariate random-effects model with correlation between sensitivity and specificity (whenever possible). Decision models were used to evaluate the cost-effectiveness of the NILTs. Expected costs were estimated using a NHS perspective and health outcomes were measured as quality-adjusted life-years (QALYs). Markov models were developed to estimate long-term costs and QALYs following testing, and antiviral treatment where indicated, for chronic hepatitis B (HBV) and chronic hepatitis C (HCV). NILTs were compared with each other, sequential testing strategies, biopsy and strategies including no testing. For alcoholic liver disease (ALD), we assessed the cost-effectiveness of NILTs in the context of potentially increasing abstinence from alcohol. Owing to a lack of data and treatments specifically for fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), the analysis was limited to an incremental cost per correct diagnosis. An analysis of NILTs to identify patients with cirrhosis for increased monitoring was also conducted.ResultsGiven a cost-effectiveness threshold of £20,000 per QALY, treating everyone with HCV without prior testing was cost-effective with an incremental cost-effectiveness ratio (ICER) of £9204. This was robust in most sensitivity analyses but sensitive to the extent of treatment benefit for patients with mild fibrosis. For HBV [hepatitis B e antigen (HBeAg)-negative)] this strategy had an ICER of £28,137, which was cost-effective only if the upper bound of the standard UK cost-effectiveness threshold range (£30,000) is acceptable. For HBeAg-positive disease, two NILTs applied sequentially (hyaluronic acid and magnetic resonance elastography) were cost-effective at a £20,000 threshold (ICER: £19,612); however, the results were highly uncertain, with several test strategies having similar expected outcomes and costs. For patients with ALD, liver biopsy was the cost-effective strategy, with an ICER of £822.LimitationsA substantial number of tests had only one study from which diagnostic accuracy was derived; therefore, there is a high risk of bias. Most NILTs did not have validated cut-offs for diagnosis of specific fibrosis stages. The findings of the ALD model were dependent on assuptions about abstinence rates assumptions and the modelling approach for NAFLD was hindered by the lack of evidence on clinically effective treatments.ConclusionsTreating everyone without NILTs is cost-effective for patients with HCV, but only for HBeAg-negative if the higher cost-effectiveness threshold is appropriate. For HBeAg-positive, two NILTs applied sequentially were cost-effective but highly uncertain. Further evidence for treatment effectiveness is required for ALD and NAFLD.Study registrationThis study is registered as PROSPERO CRD42011001561.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Natural History: Baseline Transition Probabilities Used In Mmentioning

confidence: 92%

Section: Natural History: Baseline Transition Probabilities Used In Mmentioning

confidence: 99%

“…The 2010 paper by Dakin et al 372 sourced transition probability data from natural history studies, economic evaluations or the placebo arms of meta-analyses or RCTs.…”

Section: Natural History: Baseline Transition Probabilities Used In Mmentioning

confidence: 99%

Section: Natural History: Baseline Transition Probabilities Used In Mmentioning

confidence: 99%

Section: Markov Model Structurementioning

confidence: 99%

See 3 more Smart Citations

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Crossan

Tsochatzis

Longworth

et al. 2015

Health Technology Assessment

143

190

View full text Add to dashboard Cite

show abstract

Hepatitis B Virus Elimination Strategies

Xu,

Terrault

2024

Curr Hepatology Rep

View full text Add to dashboard Cite

Purpose of Review The World Health Assembly called to eliminate viral hepatitis as a public health threat in 2016 and proposed elimination goals by 2030. This review examined current national and global progress with hepatitis B virus elimination, and the hurdles and solutions being undertaken to achieve elimination goals. Recent Findings Few countries are on target to achieve the elimination targets of a 95% reduction in new infections and a 65% reduction in mortality by 2030. Gaps towards elimination remain, such as low infant vaccine coverage in low-income countries and continued under-diagnosis and low rates of treatment globally. Summary HBV elimination is feasible but will require continued focus on infant and childhood vaccine coverage, improving blood and injection safety, increasing harm reduction measures among persons who use drugs, and providing broader access to low-cost diagnostics and antiviral treatment.

show abstract

Tenofovir disoproxil fumarate for the treatment of chronic hepatitis B monoinfection

2011

View full text Add to dashboard Cite

show abstract

Cost–Utility Analysis of Tenofovir Disoproxil Fumarate in the Treatment of Chronic Hepatitis B

Abstract: First-line TDF is the most cost-effective treatment for patients with CHB at a £ 20,000 to £ 30,000/QALY ceiling ratio, costing £ 19,084/QALY gained compared with the next best alternative.

Cited by 39 publications

References 38 publications

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Cost-effectiveness of non-invasive methods for assessment and monitoring of liver fibrosis and cirrhosis in patients with chronic liver disease: systematic review and economic evaluation

Hepatitis B Virus Elimination Strategies

Tenofovir disoproxil fumarate for the treatment of chronic hepatitis B monoinfection

Contact Info

Product

Resources

About