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

Abstract

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...

Health Policy on the pages of Revista de Saúde Pública

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Telbivudine for the treatment of chronic hepatitis B in HBeAg-positive patients in China: a health economic analysis

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Application of Bayesian Approach to Cost-Effectiveness Analysis of Antiviral Treatments in Chronic Hepatitis B

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