Pharmacoeconomic Evaluation Of Nucleoside Analogues And Peginterferon Alfa-2a In The Treatment Of HBeAg-negative Chronic Hepatitis B

BACKGROUND:Chronic hepatitis B（CHB）is caused by the hepatitis B virus(HBV) infection.According to the World Health Organization（WHO）reported that about2billionpeople who were infected with HBV in the world,350million people are carriers ofHBV among them. The HBV infection rate is still high in China and Hepatitis Bsurface antigen carry rate is7.18%in the general population. Relevant data show thatChina’s Hepatitis B e antigen negative CHB in the proportion of patients with CHB is37%~54%and the number has a tendency to increase year by year. HBeAg-negativeCHB patients are more likely to develop liver cirrhosis and hepato cellular carcinoma(HCC) than HBeAg-positive CHB patients. The key for the treatment of CHB isantiviral treatment. There are a large number of comparative studies about the efficacyof all kinds of antiviral drugs, the curative effect of drugs is basic clear. But the courseof treatment for CHB is long and the drug price is relatively expensive, the cost oftreatment for some patients is a huge economic burden in our country which theeconomic is less developed and the health care system is still improving. So weshould not only consider the effect also need to consider the economic factor whenchoosing drugs. There are a few economic studies for CHB about both four kinds ofnucleoside drugs and peginterferon alfa-2a, less about HBeAg-negative CHB amongthem.Objective:1. To evaluate long term cost-effectiveness of nucleoside analogues and peginterferon alfa-2a for the treatment of HBeAg-negative CHB so that we canchoose a suitable therapeutic schedule.2. To provide reference information for the treatment of HBeAg-negative CHB,the formulation of health policy and the adjustment of drug price.Methods:1. Building a multi-health state Markov model which based on the natural historyof CHB.2. Gathering transition probability, life quality score and medical expenses in theMarkov model through querying literature and consulting experts.3. Using the nucleoside drugs and peginterferon alfa-2a for the treatment ofHBeAg-negative CHB to calculate the quality adjusted life years and later50years’medical expenses in the Markov model. Incremental cost-effectiveness analysis wasthen carried out.Results:1. In comparison with no antiviral treatment，all the antiviral treatments canprolong CHB patients life years. The most effective treatment for HBeAg-negativeCHB is entecavir plus adefovir rescue medication after drug resistance occurredadministered for2years, which can get10.12quality adjusted life years and prolong1.12quality adjusted life years than no antiviral treatment.2. The least cost treatment for HBeAg-negative CHB is lamivudine plus adefovirrescue medication after drug resistance occurred administered for2years. The totalexpense is165923yuan and annual expense is8562yuan.3. The most cost-effective treatment for HBeAg-negative CHB is lamivudineplus adefovir rescue medication after drug resistance occurred administered for2years. The incrementl medical cost is16273yuan per QALY gained.4. The sensitivity analysis by changing the discount rate or the conversion rate ofprogression in disease or virological response rate has been used to verify thestability of the results. Conclusion:1. In comparison with no antiviral treatment, the use of nucleoside drugs andpeginterferon alfa-2a all can prolong HBeAg-negative CHB patients’ life years.2. At present, the most effective treatment for HBeAg-negative CHB is entecavirsolution in China.3.Do the threshold reference to GDP, lamivudine plus adefovir rescue medicationafter drug resistance occurred administered is more cost-effective than others...