Incorporated antivirals for chronic hepatitis B in Brazil: a cost-effectiveness analysis.
Rev Saude Publica
; 47(4): 769-78; discussion 779, 2013 Aug.
Article
en En, Pt
| MEDLINE
| ID: mdl-24346678
ABSTRACT
OBJECTIVE:
To evaluate the cost-effectiveness of different drug therapies for chronic hepatitis B in adult patients.METHODS:
Using a Markov model, a hypothetical cohort of 40 years for HBeAg-positive or HBeAg-negative patients was constructed. Adefovir, entecavir, tenofovir and lamivudine (with rescue therapy in cases of viral resistance) were compared for treating adult patients with chronic hepatitis B undergoing treatment for the first time, with high levels of alanine aminotransferase, no evidence of cirrhosis and without HIV co-infection. Values for cost and effect were obtained from the literature, and expressed in effect on life years (LY). A discount rate of 5% was applied. Univariate sensitivity analysis was conducted to assess model uncertainties.RESULTS:
Initial treatment with entecavir or tenofovir showed better clinical outcomes. The lowest cost-effectiveness ratio was for entecavir in HBeAg-positive patients (R$ 4,010.84/LY) and lamivudine for HBeAg-negative patients (R$ 6,205.08/LY). For HBeAg-negative patients, the incremental cost-effectiveness ratio of entecavir (R$ 14,101.05/LY) is below the threshold recommended by the World Health Organization. Sensitivity analysis showed that variation in the cost of drugs may make tenofovir a cost-effective alternative for both HBeAg-positive and HBeAg-negative patients.CONCLUSIONS:
Entecavir is the recommended alternative to start treating patients with chronic hepatitis B in Brazil. However, if there is a reduction in the cost of tenofovir, it can become a cost-effective alternative.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Antivirales
/
Hepatitis B Crónica
Tipo de estudio:
Health_economic_evaluation
Límite:
Adult
/
Humans
País/Región como asunto:
America do sul
/
Brasil
Idioma:
En
/
Pt
Revista:
Rev Saude Publica
Año:
2013
Tipo del documento:
Article
País de afiliación:
Brasil