Cost-effectiveness of antiviral therapy in untreated compensated cirrhosis patient with serum HBV–DNA level < 2000 IU/mL

Hankil Lee, Sungin Jang, Sang Hoon Ahn, Beom Kyung Kim

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Background: Due to stringent reimbursement criteria, significant numbers of patients with compensated cirrhosis (CC) and low-level viremia [LLV; serum hepatitis B virus (HBV)–DNA levels of 20–2000 IU/mL] remain untreated especially in the East Asian countries, despite potential risk of disease progression. We analyzed cost-effectiveness to assess rationales for antiviral therapy (AVT) for this population. Methods: We compared cost and effectiveness (quality-adjusted life years, QALYs) in a virtual cohort including 10,000 54-year-old CC-LLV patients receiving AVT (Scenario I) versus no treatment (Scenario II). A Markov model, including seven HBV-related conditions, was used. Values for transition probabilities and costs were mostly obtained from recent real-world South Korean data. Results: As per a simulation of a base-case analysis, AVT reduced costs by $639 USD and yielded 0.108 QALYs per patient for 5 years among CC-LLV patients compared to no treatment. Thus, AVT is a cost-saving option with lower costs and better effectiveness than no treatment. If 10,000 patients received AVT, 815 incident cases of hepatocellular carcinoma (HCC) and 630 HBV-related deaths could be averted in 5 years compared to no treatment. In case of 10-year observation, AVT was consistently dominant. Even when the transition probabilities from CC-LLV vs. maintained virological response to HCC were same, fluctuation of results also lied within willingness-to-pay in South Korea. In the probabilistic sensitivity analysis with the willingness-to-pay threshold, the probability of AVT cost-effectiveness was 100%. Conclusion: The extended application of AVT in CC-LLV patients may contribute positively to individual clinical benefits and national healthcare budgets.

Original languageEnglish
Pages (from-to)294-305
Number of pages12
JournalHepatology International
Volume16
Issue number2
DOIs
Publication statusPublished - 2022 Apr

Bibliographical note

Publisher Copyright:
© 2022, Asian Pacific Association for the Study of the Liver.

All Science Journal Classification (ASJC) codes

  • Hepatology

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