Cost-effectiveness of antiviral therapy for chronic hepatitis B: A systematic review

Objectives: To evaluate published cost-effectiveness analyses (CEA) assessing nucleos(t)ide analogues (NAs), interferon, and pegylated interferon for chronic hepatitis B (CHB). Methods: Main medical databases in both English and Chinese were searched up to October 2012 to identify eligible studies for data extraction. The base case incremental costeffectiveness ratio (ICER) per quality-adjusted life year (QALY) was adjusted to 2011 local currency value and presented by the ratio to 2011 gross domestic product per capita (GDPPC). Simple linear regression analyses took adjusted ICER per QALY as dependent variable to assess the costeffectiveness of antiviral therapy when compared to lamivudine. Results: 81 studies published in English and 18 studies published in Chinese were identified. When compared to no treatment, all NAs were associated with an ICER per QALY of less than 1 GDPPC in high or middle-income countries. When compared to lamivudine, entecavir was associated with an ICER per QALY of less than 1 GDPPC in high or middle-income countries. Simple linear regression analyses observed significantly reduced ICER per QALY associated with entecavir (coefficient -1.450, P= 0.018) but significantly increased ICER per QALY associated with interferon (coefficient 5.583, P< 0.001) or adefovir (coefficient 2.354, P< 0.001) when compared to lamivudine. Telbivudine, tenofovir and pegylated interferon did not have significant impact on ICER per QALY when lamivudine was the reference. One study published in Chinese was considered high quality and reported the lowest ICER per QALY associated with entecavir when compared to no treatment in patients with positive or negative hepatitis B e antigen (HBeAg). Conclusions: When compared to no treatment, NAs were highly cost-effective for CHB in high or middle-income countries. When compared to lamivudine, entecavir was the most cost-effective treatment among NAs. Entecavir was also the most cost-effective NA when compared to no treatment in Chinese patients with CHB, irrespective of their HBeAg status.