Cost-Effectiveness Analysis of Lamivudine for the Treatment of Chronic Hepatitis B

Crowley, Steven J.
Tognarini, David
Desmond, Paul V.
Lees, Michael

¹ Glaxo Wellcome Australia, Melbourne, Victoria, Australia
² Centre for Health Program Evaluation, The University of Melbourne, Victoria, Australia
³ Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia
⁴ Medical Technology Assessment Group, Sydney, New South Wales, Australia

Correspondence and offprints: Mr Steven Crowley, c/o Centre for Health Program Evaluation, Boronia House, The Austin and Repatriation Medical Centre, Banksia Street, Heidelberg 3084, Australia. E-mail: [email protected]

PharmacoEconomics 17(5):p 409-427, 2000.

Objective

To estimate the short term and long term cost effectiveness, from a healthcare perspective, associated with the introduction of lamivudine for chronic hepatitis B.

Design

The analysis used a 2-step modelling approach. A decision tree was used to estimate clinical outcomes and costs after 1 year. The 1-year results were then extrapolated to 70 years using a Markov model.

Patients

The study population comprised hypothetical cohorts of patients with chronic hepatitis B, representative of those likely to receive treatment in clinical practice in Australia.

Main outcome measures and results

In the short term, more patients seroconverted when lamivudine was available, with an incremental cost-effectiveness ratio of 3341 Australian dollars ($A) per additional seroconversion. In the long term, the introduction of lamivudine increased life expectancy by 3.9 years [3.2 quality-adjusted life-years (QALYs)] compared with when interferon-α was the only treatment, or 4.6 years (3.8 QALYs) compared with no treatment. There were reductions in lifetime risk of developing compensated cirrhosis, decompensated cirrhosis and hepatocellular carcinoma of 5, 11 and 11%, respectively, when lamivudine was available. The incremental cost of having lamivudine available, as opposed to interferon-α only, was $A633 per year of life saved or $A735 per QALY.

Conclusion

The introduction of lamivudine is expected to reduce and delay the progression of chronic hepatitis B, increasing the life expectancy and quality of life of patients for a small overall increase in healthcare costs.