Cost-Effectiveness of Anti-Viral Treatment in Patients with Immune-Tolerant Phase Chronic Hepatitis B = Cost-Effectiveness of Anti-Viral Treatment in Patients with Immune-Tolerant Phase Chronic Hepatitis B

다국어 초록 (Multilingual Abstract)

Aims: Currently, antiviral therapy for chronic hepatitis B (CHB) patients in immune tolerant (IT) phase is generally not recommended. There has been a need for studies assessing benefits of antiviral therapy in IT-phase. A recent study showed that untreated IT-phase patients had higher risk of hepatocellular carcinoma (HCC) than treated immune active (IA) phase patients. We aimed to evaluate the cost-effectiveness of starting antiviral treatment from IT-phase (IT-Tx) compared to delaying the treatment to IA-phase (IA-Tx).
Methods: We designed a Markov model to compare expected costs and quality-adjusted life-years (QALYs) between IT-Tx group and IA-Tx group from healthcare system and societal perspectives. Transition probabilities and costs were obtained from a cohort of 4,965 HBeAg-positive, treatment-naive CHB patients at Asan Medical Center. Literature review was conducted for other parameters. Cost and effectiveness were discounted at a 5% annual rate, and incremental cost-effectiveness ratio (ICER) was calculated for 10-year horizon and evaluated with various HCC risks.
Results: The cost-effectiveness analysis showed that IT-Tx group had ₩6,996,562 incremental costs and additional 0.294 QALY per patient compared to IA-Tx group with 10-year cumulative HCC risk of 10% (base-case). ICER was ₩23,819,529/QALY, which was borderline high of the cost-effectiveness threshold (₩20,000,000/QALY) in Korea. As HCC risk increased, IT-Tx became acceptable in cost-effectiveness. When the HCC risk increased over 11.8%, ICER went below the threshold. The analysis including the cost of lost productivity showed that IT-Tx was dominant with HCC risk greater than 4.6% (ICER<0).
Conclusions: To start antiviral therapy for CHB patients in IT-phase was borderline high cost-effective from healthcare system perspective dealing with the only medical costs, however, it was a dominant strategy in view of societal perspective covering also the costs for lost productivity.