Costbenefit of hepatitis B treatment A presentation at the 14th National Symposium on Hepatitis B an

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Cost/benefit of hepatitis B treatmentA
presentation at the14th National Symposium on
Hepatitis B and CSt Vincents HospitalMelbourne
Saturday,18 November 2006

• Jim Butler
• Australian National University

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Overview

• Two components
• Cost of treating hepatitis B patients
• Cost-effectiveness of alternative therapies

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Cost of treating hepatitis B patients

• The Direct Cost of Managing Patients With Chronic
  Hepatitis B Infection in Australia
• Journal of Clinical Gastroenterology, 38
  (Supp.3), Nov/Dec 2004, pp.S187-S192.
• James RG Butler, BEcon MPolEcon PhD
• Stephen Pianko, MBBS FRACP PhD
• Rosemary J. Korda, BAppSci MAppSci GradDipPopHlth
• Shara Nguyen, BSc
• Paul J. Gow, MBBS FRACP PhD
• Stuart K. Roberts, MBBS FRACP MD
• Simone I. Strasser, MBBS FRAC, MD
• William Sievert, MBBS FRACP MD

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• Retrospective analysis - 149 patients - six
  disease states- non-cirrhotic CHB-
  compensated cirrhosis- decompensated
  cirrhosis- hepatocellular carcinoma- liver
  transplantation in year 1- liver
  transplantation in subsequent years
• Cost of palliative care - 53 patients - chronic
  hepatitis and hepatocellular carcinoma - data
  from palliative care unit.

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Demographic characteristics of sample
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1-year costs of managing hep B patients
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LOS and cost per patient institutionalised
palliative care for HCC
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Cost-effectiveness analysis

• Treatment Alternatives for Chronic Hepatitis B
  Virus Infection A Cost-Effectiveness Analysis
• Annals of Internal Medicine, 142(10), May 2005,
  pp.821-31.
• Kanwal et al

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• Treatment strategies
• 1) No HBV treatment (do nothing strategy)
• 2) interferon monotherapy
• 3) lamivudine monotherapy
• 4) adefovir monotherapy
• 5) lamivudine with crossover to adefovir upon
  resistance (adefovir salvage strategy)

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• Results
• The do nothing strategy was least effective yet
  least expensive
• Compared with the do nothing strategy, using
  interferon cost an incremental 6337 to gain 1
  additional QALY.
• Compared with interferon, the adefovir salvage
  strategy cost an incremental 8446 per QALY
  gained.
• Both the lamivudine and adefovir monotherapy
  strategies were more expensive yet less effective
  than the alternative strategies and were
  therefore dominated.

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• Caveats
• Lamivudine resistance may compromise efficacy of
  new nucleoside analogue (Entecavir) analysis
  does take adequate account of problems of
  lamivudine resistence (Weitzman et al 2005)
• The findings apply only to patients with
  persistently elevated aminotransferase levels and
  no cirrhosis.
• The authors did not model the cost-effectiveness
  of nucleoside analogue salvage after interferon
  therapy failure