Cost‐effectiveness of suppressing hepatitis B virus DNA in immune tolerant patients to prevent hepatocellular carcinoma and cirrhosis
- 25 May 2007
- journal article
- research article
- Published by Wiley in Alimentary Pharmacology & Therapeutics
- Vol. 26 (3), 383-391
- https://doi.org/10.1111/j.1365-2036.2007.03382.x
Abstract
For patients with hepatitis B virus (HBV) infection in the immune tolerant phase, the current standard of care is to not offer treatment. However, the recent Risk Evaluation of the Viral Load Elevation and Associated Liver Disease/Cancer-In study results show a striking relationship between high HBV DNA levels and risk for hepatocellular carcinoma and cirrhosis. In a cost effectiveness analysis, to assess whether immune tolerant patients with high HBV DNA levels should undergo treatment. We created a lifetime Markov model to evaluate the cost-effectiveness of two strategies for immune tolerant hepatitis B: (i) HBV DNA suppression with lamivudine, (ii) no treatment. Patients cycled between the following health states: viral suppression, ongoing viremia, seroconversion, hepatocellular carcinoma, cirrhosis and death. Compared with the no treatment strategy, lamivudine therapy was more expensive but more cost-effective with an additional cost of $5784 and $12 584 per quality adjusted life year gained in males and females, respectively. Treatment resulted in a gain in life expectancy and a decrease in lifetime risk of hepatocellular carcinoma and cirrhosis. Suppressing HBV DNA to prevent hepatocellular carcinoma and cirrhosis in immune tolerant patients is very cost-effective, and treatment of these patients may be considered. Future prospective clinical trials will need to be undertaken to confirm our findings.Keywords
This publication has 47 references indexed in Scilit:
- Hepatocellular Carcinoma and Hepatitis B VirusSeminars in Liver Disease, 2006
- Predicting Cirrhosis Risk Based on the Level of Circulating Hepatitis B Viral LoadGastroenterology, 2006
- A 1-Year Trial of Telbivudine, Lamivudine, and the Combination in Patients With Hepatitis B e Antigen—Positive Chronic Hepatitis BGastroenterology, 2005
- Chronic hepatitis B virus infection in the Asia–Pacific region and Africa: Review of disease progressionJournal of Gastroenterology and Hepatology, 2005
- Durability of serologic response after lamivudine treatment of chronic hepatitis BHepatology, 2003
- Predictors of HBeAg loss after lamivudine treatment for chronic hepatitis BHepatology, 2002
- Long‐Term Entecavir Treatment Results in Sustained Antiviral Efficacy and Prolonged Life Span in the Woodchuck Model of Chronic Hepatitis InfectionThe Journal of Infectious Diseases, 2001
- Lamivudine as Initial Treatment for Chronic Hepatitis B in the United StatesNew England Journal of Medicine, 1999
- Occurrence of hepatocellular carcinoma and decompensation in western european patients with cirrhosis type BHepatology, 1995
- Age‐specific prevalence and significance of hepatitis B e antigen and antibody in chronic hepatitis B virus infection in taiwan: A comparison among asymptomatic carriers, Chronic hepatitis, liver cirrhosis, and hepatocellular carcinomaJournal of Medical Virology, 1984