Cost-effectiveness analysis of lamivudine for the treatment of chronic hepatitis B

Objective: To estimate the short term and long term cost effectiveness, fro m 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 resul ts were then extrapolated to 70 years using a Markov model. Patients: The study population comprised hypothetical cohorts of patients w ith chronic hepatitis B, representative of those likely to receive treatmen t in clinical practice in Australia. Main outcome measures and results: In the short term, more patients serocon verted when lamivudine was available, with an incremental cost-effectivenes s ratio of 3341 Australian dollars ($A) per additional seroconversion. In t he long term, the introduction of lamivudine increased life expectancy by 3 .9 years [3.2 quality-adjusted life-years (QALYs)] compared with when inter feron-alpha was the only treatment, or 4.6 years (3.8 QALYs) compared with no treatment. There were reductions in lifetime risk of developing compensa ted cirrhosis, decompensated cirrhosis and hepatocellular carcinoma of 5, 1 1 and 11%, respectively, when lamivudine was available. The incremental cos t of having lamivudine available, as opposed to interferon-alpha 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 cost s.