| BACKGROUND:Hepatitis B virus infection is an important public health issue.A variety of pharmaceuticals are currently approved for the treatment of hepatitis B e antigen(HBeAg)-positive chronic hepatitis B(CHB),but their relative economic value is unclear in China.The goal of this analysis was to compare the cost effectiveness of adefovir(ADV),entecavir(EYV),lamivudine(LMV),pegylated interferon alfa-2a and telbivudine(LDY).METHODS:We conducted a cost-utility analysis from a Chinese payer perspective over a lifetime time horizon using a Markov model,in a hypothetical population with HBeAg-positive CHB and a mean age of 30 years.We evaluated 1 year of treatment duration of pegylated interferon alfa-2a and 4 years of treatment duration of adefovir,entecavir,lamivudine,and 2 years treatment of telbivudine,with the use of salvage therapy for drug resistance.Disease progression probabilities,costs and quality-of-life data were derived from the published literature.Sensitivity analyses were conducted to evaluate uncertainty in the results.All costs were valued in RMB, year 2009 values.Costs and QALYs were discounted at 5%per anum.RESULTS:Initiation with peginterferon alpha-2a(PEG-IFNα-2a)(9.84 QALYs) and telbivudine(9.64 QALYs) provided the largest treatment benefits overall, followed by adefovir(9.49 QALYs).Initiation with PEG-IFNα-2a for 48 weeks resulted in higher discounted quality-adjusted life years(9.84 QALYs) and total healthcare costs RMB 163,044.With an increase of 0.20 QALYs compared with the next highest QALYs(telbivudine),giving an incremental cost-effectiveness ratio of RMB 7,455.CONCLUSIONS:Treatment with peginterferon alfa-2a for a defined duration of 48 weeks,although its retail price is more expensive than lamivudine,adefovir, entecavir,and telbivudine,it provides improvement in health outcomes,with the greatest clinical and economic value below the current China cost-effectiveness threshold,followed by telbivudine.
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