Cost-effectiveness of Peginterferon Alpha-2a Compared with Lamivudine Treatment in Patients with HBe-antigen-positive Chronic Hepatitis B in the United Kingdom

Published in: European Journal of Gastroenterology and Hepatology, v. 19, no. 8, Aug. 2007, p. 631-638

Posted on RAND.org on January 01, 2007

by David L. Veenstra, Sean D. Sullivan, Geoffrey M. Dusheiko, Michael Jacobs, Julia E. Aledort, Gavin Lewis, Kavita Patel

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BACKGROUND: Peginterferon [alpha]-2a (40 kDa), a new treatment for chronic hepatitis B, produces seroconversion within 48 weeks in approximately 32% of HBeAg-positive patients. Over a defined treatment duration it offers improved efficacy over lamivudine, but at higher cost. The authors assessed the clinical outcomes and costs, from the perspective of the UK National Health Service, of 48 weeks of peginterferon [alpha]-2a (40 kDa) vs. 4 years of lamivudine. METHODS: Cost-effectiveness was analysed using a state-transition Markov model simulating HBeAg-positive chronic hepatitis B natural history. Efficacy data were obtained from a large randomized trial comparing peginterferon [alpha]-2a (40 kDa) with lamivudine over 48 weeks. Use of adefovir salvage treatment for lamivudine-resistant patients was also evaluated. Long-term lamivudine efficacy, treatment durability, disease progression, cost, and quality-of-life estimates were derived from the literature. One-way and probabilistic sensitivity analyses evaluated uncertainty. RESULTS: Treatment with peginterferon [alpha]-2a (40 kDa) for 48 weeks resulted in higher discounted total healthcare costs ([pounds]3100), but an increase of 0.3 discounted quality-adjusted life years compared with long-term lamivudine, giving an incremental cost-effectiveness ratio of [pounds]10 400 per quality-adjusted life year gained ([pounds]8300-[pounds]15 400 in one-way sensitivity analyses). The cost-effectiveness acceptability curve showed intervention was below the [pounds]30 000/QALY threshold in over 95% of the simulations. When adefovir was included for patients with lamivudine resistance, peginterferon [alpha]-2a (40 kDa) had an incremental cost of [pounds]6100/QALY gained. CONCLUSIONS: Treatment with peginterferon [alpha]-2a (40 kDa) for a defined duration of 48 weeks, although more expensive than lamivudine therapy, provides improvement in health outcomes, with a cost-effectiveness ratio well below the current UK cost-effectiveness threshold.

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