The cost-effectiveness of alternative therapeutic strategies for the management of chronic hepatitis B in Poland

Abstract

Objective: The aim of the study was to estimate the cost-effectiveness of alternative therapeutic strategies for the management of chronic hepatitis B (CHB) in Poland. Methods: The model for the Polish health-care context was based on clinical data from the literature and local data on health-care resource utilization and unit costs. Costs and effects of a population of CHB patients were modeled using four scenarios, which attempt to reflect real-life practice in which patients may receive any of the treatment options available and in which a proportion of patients may still receive no treatment because therapy is not suitable. Strategies A and B assumed the availability of both treatment options: the first choice of treatment is in A, lamivudine, and in B, interferon alpha (IFN-α). In strategy C, the only approved treatment is IFN-α, and in strategy D, the patients receive no antiviral treatment. The outcome measures were HBeAg seroconversion and nonprogression to cirrhosis - the surrogate marker with predictive value for improved survival. Only direct medical costs were analyzed. The payer's perspective and time horizon of 1 year were adopted. One-way sensitivity analysis and extreme scenario analysis were performed. Results: The best results in terms of seroconversion and nonprogression to cirrhosis were achieved for strategy A, costs were lowest for strategy D, and strategies B and C were dominated by strategy A. The incremental cost/effectiveness ratio (ICER) comparing strategy A with strategy D was 57,855 Polish new zloty (PLN) per extra seroconversion and 79,550 PLN per cirrhosis case avoided. Conclusions: Cirrhosis reduces estimated life expectancy by 37.76 years and by 20 years among 30- and 50-year-olds, respectively. The ICER for strategies A and D was 2105 PLN and 3978 PLN per life-years gained for the population at ages 30 and 50, respectively, and was below the suggested threshold for cost-effectiveness, based on treatment costs for 1 year of hemodialysis in Poland (62,400 PLN). Changing the value of key drivers for sensitivity analysis did not have a significant effect on the ICER.