Incorporated antivirals for chronic hepatitis B in Brazil: a cost-effectiveness analysis

Gustavo Laine Araújo de Oliveira Alessandra Maciel Almeida Anderson Lourenço da Silva Cristina Mariano Ruas Brandão Eli Iola Gurgel Andrade Mariângela Leal Cherchiglia Francisco de Assis Acurcio About the authors

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.

Hepatitis B, Chronic, drug therapy; Antiviral Agents, supply & distribution; Cost-Effectiveness Evaluation; Unified Health System, economics


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