Cost-effectiveness analysis of oral anti-viral drugs used for treatment of chronic hepatitis B in Turkey

Abstract

Background: All international guidelines suggested that Tenofovir and Entecavir are the primary drugs at the first line therapy for the treatment of chronic hepatitis B (CHB). However, in Turkey these medications reimbursed at the second line therapy according to the Healthcare Implementation Notification. The aim of this study is to compare the cost effectiveness of oral antiviral treatment strategies in CHB for Turkey using lamuvidine, telbuvidine, entecavir, and tenofovir as medications. Methods: The analysis was conducted using Markov models. The analysis scenarios based on first line treatment options with Lamuvidine, Telbuvidine, Entecavir, and Tenofovir as the medications. In the analysis, inadequate response or resistance after receiving 12months of the treatment with Entecavir and Telbivudine were compared to the results found from switching from Entecavir to Tenofovir or from switching from Telbuvidine to Tenofovir. In additional, inadequate response or resistance after receiving 6months of the treatment for Lamivudine was compared to the results found from switching from Lamivudine to Tenofovir. The study population included men and women, who were 40years of age. The patients` compliance was estimated 100% for all of the therapy options. The model duration was constructed to evaluate, treatment strategy duration of 40years. The cost of medications, examinations/follow-ups and complications were included in the model. Years of Potential Life Lost was used as the health outcome. An incremental cost-effectiveness ratio analysis has been conducted. Results and discussion: While the minimum years of life lost was found as 0.22 with tenofovir treatment in 5years, treatment cost was calculated as 12,169 TL. These values were detected as 0.56years and 7727 TL, 0.37years and 12,770 TL, respectively for lamuvidine and telbuvidine treatments. The maximum years of life lost and treatment cost was with lamuvidine treatment were detected as 1.60years and 18,813 TL and, secondly 0.89years and 24,007 TL for lamuvidine-tenofovir treatment during 10years. The minimum years of life lost and cost are 0.54year and 35,821 TL for tenofovir treatment during 10years. The minimum years of life lost and cost were determined as 1.21years and 52,839 TL for tenofovir treatment strategy during 20years. During 30years period, tenofovir treatment was found to have the minimum years of life lost (1.73years) and minimum cost (84,149 TL). When the results of 40years period were analyzed, years of life lost and costs are 2.06years and 119,604 TL, 2.13years and 162,115 TL, 2.13years and 161,642 TL, 6.52years and 147,245 TL, 3.20years and 132,157 TL, 4.10years and 151,059 TL and 3.05years and 138,182 TL for tenofovir, entecavir, entecavir-tenofovir, lamuvidine, lamuvidine-tenofovir, telbivudine and telbivudine-tenofovir. Conclusions: In the model presented in this study, in cost effectiveness analysis about CHB treatments, Tenofovir was found to be one of the cost effective methods in comparison with other treatment strategies different time intervals. Beyond this achievement Tenofovir has shown to reduce cumulative treatment cost in first line CHB treatment when compared with regard to 40year cumulative treatment cost.