Reuters Health Information (2005-05-17): Hybrid salvage strategy cost-effective for chronic hepatitis B treatment
Hybrid salvage strategy cost-effective for chronic hepatitis B treatment
Last Updated: 2005-05-17 15:47:14 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A hybrid salvage strategy
that reserves adefovir treatment for lamivudine-resistant chronic
hepatitis B appears cost-effective for most patients, according to a
"Despite the effectiveness of adefovir in hepatitis B, it is simply
not cost-effective to use it routinely as first-line therapy in all
comers with hepatitis B," Dr. Brennan M.R. Spiegel from the David
Geffen School of Medicine at UCLA, told Reuters Health. "Instead, it
appears more prudent from a health economics perspective to save
adefovir for when it's most useful -- namely, when lamivudine
resistance has already occurred."
Dr. Spiegel and colleagues performed an economic analysis to
estimate the cost-effectiveness of several strategies for managing
chronic hepatitis B virus infection in patients with elevated liver
enzyme levels and no evidence of cirrhosis.
Interferon monotherapy was associated with an incremental $6337 per
quality adjusted life-year (QALY) gained, compared with doing nothing,
the authors report. Adefovir salvage therapy (crossing over from
lamivudine to adefovir when lamivudine resistance appears) was
associated with an additional $8446 per QALY, compared with interferon
Lamivudine and adefovir monotherapy were more expensive and less
effective than the other strategies, the researchers report in the in
the May 17th Annals of Internal Medicine.
Similar results were obtained when only HBeAg-negative patients were
considered, the researchers note, although all the strategies became
more expensive and less effective.
In contrast, adefovir salvage strategy became the most effective and
least expensive approach for patients who are HBeAg positive, the
Three Monte Carlo analyses supported these findings, revealing that
adefovir salvage strategy is most cost-effective in HBeAg-positive
patients and that interferon monotherapy is most cost-effective in
health care systems with tight budgetary constraints and a high
prevalence of HBeAg-negative patients.
"Don't write-off interferon," Dr. Spiegel said. "It still has a
role, especially in HBeAg negative patients and in health care settings
that simply cannot afford other types of therapy."
"The conclusion that adefovir salvage is a dominant (HBeAg-positive
patients) or cost-effective (HBeAg-negative patients) strategy may
change if newer drugs, or combinations of current drugs, are more
effective, cheaper, or both," write Dr. Douglas K. Owens from VA Palo
Alto Health Care System in California and Dr. Martin Black from Temple
University School of Medicine, Philadelphia, in a related editorial.
"It's important to understand that hepatitis B is a significant
health problem, despite being nearly eclipsed by hepatitis C in terms
of publicity," Dr. Spiegel added. "From a global standpoint, hepatitis
B carries a much larger burden of illness."
Ann Intern Med 2005;142:821-831,863-864.