The University of Southampton
University of Southampton Institutional Repository

A systematic review and economic evaluation of adefovir dipivoxil and pegylated interferon-alpha-2a for the treatment of chronic hepatitis B.

A systematic review and economic evaluation of adefovir dipivoxil and pegylated interferon-alpha-2a for the treatment of chronic hepatitis B.
A systematic review and economic evaluation of adefovir dipivoxil and pegylated interferon-alpha-2a for the treatment of chronic hepatitis B.
Standard treatments for chronic hepatitis B (CHB) include interferon-alpha (IFN-alpha) and lamivudine (LAM), but these are associated with adverse effects and viral resistance, respectively. The aim of this systematic review and economic evaluation was to assess the clinical effectiveness and cost-effectiveness of two alternative drugs for the treatment of adults with CHB: adefovir dipivoxil (ADV) and pegylated IFN-alpha-2a. We searched electronic databases, including Cochrane Systematic Reviews and Medline, for literature that met criteria defined in a research protocol. Retrieved articles were independently assessed for inclusion by two reviewers. We developed a Markov state transition model to estimate the cost-effectiveness (cost-utility) of pegylated IFN-alpha-2a and of ADV compared with nonpegylated IFN-alpha-2a, LAM and best supportive care. Seven randomized controlled trials and two systematic reviews met the inclusion criteria for our review of clinical effectiveness. ADV was significantly more effective than placebo or ongoing LAM in reducing levels of hepatitis B virus (HBV) DNA. Rates of hepatitis B e antigen (HBeAg) seroconversion were higher among patients receiving ADV than either placebo or ongoing LAM. Patients treated with pegylated IFN-alpha-2a, either as monotherapy or in combination with LAM, showed significantly reduced HBV DNA levels compared with patients treated with LAM monotherapy. HBeAg seroconversion rates at follow-up were significantly higher for pegylated IFN-alpha-2a patients than for those receiving LAM monotherapy. Results of our cost-effectiveness analysis demonstrate that incremental costs per quality adjusted life year (QALY) for a range of comparisons were between 5,994 and 16,569 British Pound, and within the range considered by NHS decision-makers to represent good value for money.
adefovir dipivoxil, cost-effectiveness, economic evaluation, hepatitis B, pegylated interferon-alpha, systematic review
1352-0504
75-88
Takeda, A.
f6243016-c00a-46eb-bb0d-dbbbc4dcdd6e
Jones, J.
270b303b-6bad-4be7-8ea0-63d0e8015c91
Shepherd, J.
dfbca97a-9307-4eee-bdf7-e27bcb02bc67
Davidson, P.
531fc501-2ab0-4481-900e-2e7c0cc6424d
Price, A.
43084e97-b383-4dd5-9ae9-df4fc8626e99
Takeda, A.
f6243016-c00a-46eb-bb0d-dbbbc4dcdd6e
Jones, J.
270b303b-6bad-4be7-8ea0-63d0e8015c91
Shepherd, J.
dfbca97a-9307-4eee-bdf7-e27bcb02bc67
Davidson, P.
531fc501-2ab0-4481-900e-2e7c0cc6424d
Price, A.
43084e97-b383-4dd5-9ae9-df4fc8626e99

Takeda, A., Jones, J., Shepherd, J., Davidson, P. and Price, A. (2007) A systematic review and economic evaluation of adefovir dipivoxil and pegylated interferon-alpha-2a for the treatment of chronic hepatitis B. Journal of Viral Hepatitis, 14 (2), 75-88. (doi:10.1111/j.1365-2893.2006.00808.x). (PMID:17244247)

Record type: Article

Abstract

Standard treatments for chronic hepatitis B (CHB) include interferon-alpha (IFN-alpha) and lamivudine (LAM), but these are associated with adverse effects and viral resistance, respectively. The aim of this systematic review and economic evaluation was to assess the clinical effectiveness and cost-effectiveness of two alternative drugs for the treatment of adults with CHB: adefovir dipivoxil (ADV) and pegylated IFN-alpha-2a. We searched electronic databases, including Cochrane Systematic Reviews and Medline, for literature that met criteria defined in a research protocol. Retrieved articles were independently assessed for inclusion by two reviewers. We developed a Markov state transition model to estimate the cost-effectiveness (cost-utility) of pegylated IFN-alpha-2a and of ADV compared with nonpegylated IFN-alpha-2a, LAM and best supportive care. Seven randomized controlled trials and two systematic reviews met the inclusion criteria for our review of clinical effectiveness. ADV was significantly more effective than placebo or ongoing LAM in reducing levels of hepatitis B virus (HBV) DNA. Rates of hepatitis B e antigen (HBeAg) seroconversion were higher among patients receiving ADV than either placebo or ongoing LAM. Patients treated with pegylated IFN-alpha-2a, either as monotherapy or in combination with LAM, showed significantly reduced HBV DNA levels compared with patients treated with LAM monotherapy. HBeAg seroconversion rates at follow-up were significantly higher for pegylated IFN-alpha-2a patients than for those receiving LAM monotherapy. Results of our cost-effectiveness analysis demonstrate that incremental costs per quality adjusted life year (QALY) for a range of comparisons were between 5,994 and 16,569 British Pound, and within the range considered by NHS decision-makers to represent good value for money.

Full text not available from this repository.

More information

Published date: February 2007
Keywords: adefovir dipivoxil, cost-effectiveness, economic evaluation, hepatitis B, pegylated interferon-alpha, systematic review
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 345713
URI: http://eprints.soton.ac.uk/id/eprint/345713
ISSN: 1352-0504
PURE UUID: a9c1f3d9-d464-4b65-9f17-36384b3e797d
ORCID for J. Shepherd: ORCID iD orcid.org/0000-0003-1682-4330
ORCID for P. Davidson: ORCID iD orcid.org/0000-0003-0388-6356

Catalogue record

Date deposited: 25 Feb 2013 16:16
Last modified: 18 Feb 2021 16:44

Export record

Altmetrics

Contributors

Author: A. Takeda
Author: J. Jones
Author: J. Shepherd ORCID iD
Author: P. Davidson ORCID iD
Author: A. Price

University divisions

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×