Jones, J. and Shepherd, J.
Estimating the cost effectiveness of single agent and combination anti-viral treatment strategies for patients with chronic hepatitis B.
In, 5th Annual Meeting of Health Technology Assessment International, Montreal, Canada,
06 - 09 Jul 2008.
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Background: Anti-viral treatment can avoid or delay progressive liver disease resulting from ChronicHepatitis B. However, long term treatment is associated with high rates of resistance, resulting in theadoption of combination therapies despite limited evidence of benefit (in terms of efficacy or reducedresistance). Combination therapy is up to five times the cost of first-line monotherapy.Objective: To estimate the cost effectiveness of anti-viral treatments in combination, as sequencesand as monotherapies.Methods: A previously published economic model was adapted to include sequential and combinationtreatments as well as monotherapies. Evidence on effectiveness and resistance for established antiviralagents (lamivudine and adefovir) from a systematic review was supplemented by searches forevidence on effectiveness and resistance for sequential and combination treatment strategies.Results: Sequential and combination treatment strategies yield benefits over monotherapies, but atsubstantial additional costs (lamivudine followed by adefovir yields 0.5 additional QALYs at anadditional cost of £9,300 compared with lamivudine alone, whereas lamivudine in combination withadefovir yields 0.9 additional QALYs at an additional cost of £23,000). At a cost effectivenessthreshold of £30,000, the population expected value of perfect information (EVPI) is £58 million.Parameters with greatest EVPI in the model relate to natural history of disease, treatment efficacy andresistance.
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