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Chien HT, Su TH, Huang H, Chiang CL, Lin FJ. Real-world epidemiology, treatment patterns and disease burden of patients diagnosed with chronic hepatitis B in Taiwan. Liver Int 2023; 43:2404-2414. [PMID: 37615056 DOI: 10.1111/liv.15702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 08/07/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND AIMS This study aimed to update the epidemiology, clinical, and economic outcomes of patients diagnosed with chronic hepatitis B (CHB) infection in Taiwan. METHODS This is a retrospective observational study using claims data from the National Health Insurance Research Database. Cases were identified between 2010 and 2019 using CHB diagnosis codes and claims for alanine aminotransferase laboratory tests or CHB treatment within one year of the first CHB diagnosis. Patient characteristics, epidemiology, clinical, and economic outcomes were described. RESULTS A total of 730 154 CHB-diagnosed cases were identified. The prevalence of diagnosed CHB increased from 1.13% in 2010 to 2.43% in 2019, with the highest occurring among those aged 55-64 years (4.76%) and 45-54 years (4.37%) and being higher in men (2.98%) than in women (2.21%). The majority of newly diagnosed CHB patients were 35 years of age or older (86.6%), with a median age of 49 years. After a median follow-up period of 6.42 years, 12.5%, 7.9%, 2.8%, and 0.35% were diagnosed with cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation respectively. Among 456 706 incident CHB-diagnosed patients, 17.4% had received at least one CHB medication, with the majority taking entecavir (67.9%). Patients with increasing disease severity had higher healthcare resource utilization, and inpatient costs accounted for 48.9%-65.5% of the overall medical cost in different health states. CONCLUSION Despite the decreasing incidence of newly diagnosed CHB, the prevalence of diagnosed CHB remains high and poses a significant healthcare challenge owing to the high economic burden associated with the complications of CHB.
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Affiliation(s)
- Hsiu-Ting Chien
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Tung-Hung Su
- Division of Gastroenterology and Hepatology Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University, College of Medicine, Taipei, Taiwan
- Hepatitis Research Center National, Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan
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Wigfield P, Sbarigia U, Hashim M, Vincken T, Heeg B. Are Published Health Economic Models for Chronic Hepatitis B Appropriately Capturing the Benefits of HBsAg Loss? A Systematic Literature Review. PHARMACOECONOMICS - OPEN 2020; 4:403-418. [PMID: 31428938 PMCID: PMC7426349 DOI: 10.1007/s41669-019-00175-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Sustained hepatitis B surface antigen (HBsAg) loss or 'functional cure' (FC) is considered an optimal treatment endpoint by international clinical guidelines for chronic hepatitis B (CHB), yet rarely is this achieved with current standard of care (SoC). This leads to an under-reporting of FC in clinical trials, observational studies and health economic (HE) models. This paper systematically identifies and assesses how FC is incorporated in published HE models of CHB. METHODS A systematic literature review was conducted in PubMed and Embase (conducted February 2019) to review how HBsAg loss is captured in HE models. The following items were extracted: rate of (and transition probabilities to) HBsAg loss, HBsAg loss health state costs, and HBsAg loss health state utilities. RESULTS Sixty-five economics evaluations were identified, and < 50% of these (27/65) incorporated HBsAg loss in their models. Only 15/27 stated HBsAg loss health state costs, 15/27 stated HBsAg loss health state utilities, and 11/27 mentioned treatment-specific transition probabilities to HBsAg loss. The majority of sources these inputs were derived from are not transparent. CONCLUSIONS The benefits of FC in current HE models are not well captured, as FC is often not reported or not directly related to modelled treatments. This has the potential for novel agents with higher efficacy compared with SoC to be overlooked and undervalued if their worth is not appropriately communicated. In order to ensure optimal access for patients to new and effective therapies, it is important that the benefits of FC are better assessed and captured within HE models.
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Affiliation(s)
- Peter Wigfield
- Ingress-health Nederland, Hofplein 20, 3032 AC Rotterdam, The Netherlands
| | - Urbano Sbarigia
- Janssen Pharmaceutica, Turnhoutseweg 30, 2340 Beerse, Belgium
| | - Mahmoud Hashim
- Ingress-health Nederland, Hofplein 20, 3032 AC Rotterdam, The Netherlands
| | - Talitha Vincken
- Ingress-health Nederland, Hofplein 20, 3032 AC Rotterdam, The Netherlands
| | - Bart Heeg
- Ingress-health Nederland, Hofplein 20, 3032 AC Rotterdam, The Netherlands
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Scangas GA, Wu AW, Ting JY, Metson R, Walgama E, Shrime MG, Higgins TS. Cost Utility Analysis of Dupilumab Versus Endoscopic Sinus Surgery for Chronic Rhinosinusitis With Nasal Polyps. Laryngoscope 2020; 131:E26-E33. [PMID: 32243622 DOI: 10.1002/lary.28648] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 03/05/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Both endoscopic sinus surgery (ESS) and biologic therapies have shown effectiveness for medically-refractory chronic rhinosinusitis with nasal polyps (CRSwNP) without severe asthma. The objective was to evaluate cost-effectiveness of dupilumab versus ESS for patients with CRSwNP. STUDY DESIGN Cohort-style Markov decision-tree economic model with a 36-year time horizon. METHODS A cohort of 197 CRSwNP patients who underwent ESS were compared with a matched cohort of 293 CRSwNP patients from the SINUS-24 and SINUS-52 Phase 3 studies who underwent treatment with dupilumab 300 mg every 2 weeks. Utility scores were calculated from the SNOT-22 instrument in both cohorts. Decision-tree analysis and a 10-state Markov model utilized published event probabilities and primary data to calculate long-term costs and utility. The primary outcome measure was incremental cost per quality-adjusted life year (QALY), which is expressed as an Incremental Cost Effectiveness Ratio. One-way and probabilistic sensitivity analyses were performed. RESULTS The ESS strategy cost $50,436.99 and produced 9.80 QALYs. The dupilumab treatment strategy cost $536,420.22 and produced 8.95 QALYs. Because dupilumab treatment was more costly and less effective than the ESS strategy, it is dominated by ESS in the base case. One-way sensitivity analyses showed ESS to be cost-effective versus dupilumab regardless of the frequency of revision surgery and at any yearly cost of dupilumab above $855. CONCLUSIONS The ESS treatment strategy is more cost effective than dupilumab for upfront treatment of CRSwNP. More studies are needed to isolate potential phenotypes or endotypes that will benefit most from dupilumab in a cost-effective manner. LEVEL OF EVIDENCE 2C Laryngoscope, 131:E26-E33, 2021.
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Affiliation(s)
- George A Scangas
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Arthur W Wu
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Jonathan Y Ting
- Department of Otolaryngology, Indiana University, Indianapolis, Indiana, U.S.A
| | - Ralph Metson
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Evan Walgama
- Department of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, California, U.S.A
| | - Mark G Shrime
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
- Center for Global Surgery Evaluation, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Thomas S Higgins
- Department of Otolaryngology, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
- Rhinology, Sinus & Skull Base, Kentuckiana Ear, Nose & Throat, Louisville, Kentucky, U.S.A
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Scangas GA, Remenschneider AK, Su BM, Shrime MG, Metson R. The impact of asthma on the cost effectiveness of surgery for chronic rhinosinusitis with nasal polyps. Int Forum Allergy Rhinol 2017; 7:1035-1044. [PMID: 28873286 DOI: 10.1002/alr.22013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 08/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The objective of this work was to evaluate the impact of asthma on the cost-effectiveness profile of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis with nasal polyps (CRSwNP). METHODS The study design consisted of a cohort-style Markov decision-tree cost utility analysis with a 35-year time horizon. Matched cohorts of CRSwNP patients with (n = 95) and without (n = 95) asthma who underwent ESS were compared with cohorts of patients from the national Medical Expenditures Survey Panel (MEPS) database who underwent medical management for chronic rhinosinusitis (CRS). Baseline, 1-year, and 2-year health utility values were calculated from responses to the EuroQol-5 Dimension (EQ-5D) instrument in both cohorts. The primary outcome measure was the incremental cost effectiveness ratio (ICER) for each cohort. RESULTS The reference cases for CRSwNP patients with and without asthma yielded ICERs for ESS vs medical therapy alone of $12,066 per quality-adjusted life year (QALY) and $7,369 per QALY, respectively. At a willingness-to-pay threshold of $50,000/QALY, the ICER scatter plots demonstrated 86% and 99% certainty that the ESS strategy was the most cost-effective option for CRSwNP patients with and without asthma, respectively. ESS was not significantly more cost effective for CRSwNP patients without asthma (p = 0.494). CONCLUSION ESS remains cost effective compared to medical therapy for patients both with and without asthma. While the comorbidity of asthma results in an inferior ICER result, it does not result in a statistically significant negative impact on the overall cost effectiveness of ESS.
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Affiliation(s)
- George A Scangas
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
| | - Brooke M Su
- Department of Otolaryngology, University of California Los Angeles, Los Angeles, CA
| | - Mark G Shrime
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA
| | - Ralph Metson
- Department of Otolaryngology, Harvard Medical School, Boston, MA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA
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Scangas GA, Lehmann AE, Remenschneider AK, Su BM, Shrime MG, Metson R. The value of frontal sinusotomy for chronic rhinosinusitis with nasal polyps-A cost utility analysis. Laryngoscope 2017; 128:43-51. [PMID: 28815611 DOI: 10.1002/lary.26783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/26/2017] [Accepted: 06/05/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES/HYPOTHESIS The number of surgical procedures performed for frontal sinusitis and the associated costs have increased dramatically over the past decade. The purpose of this study was to evaluate the cost-effectiveness of endoscopic frontal sinusotomy (EFS) in patients with chronic rhinosinusitis with nasal polyposis (CRSwNP). STUDY DESIGN Cohort-style Markov decision-tree economic model with a 36-year time horizon. METHODS Matched cohorts of CRSwNP patients who underwent endoscopic sinus surgery (ESS) with (n = 139) and without (n = 49) EFS were compared to each other and to patients (n = 139) from the Medical Expenditures Survey Panel database who underwent medical management for chronic rhinosinusitis. Multi-year health utility values were calculated from responses to the EuroQol 5-Dimension instrument. The primary outcome measure was the incremental cost-effectiveness ratio (ICER). RESULTS Decision analysis showed that ESS without EFS proved more cost-effective than ESS with EFS or medical management. ESS without EFS compared to medical management yielded an ICER of $9,004/quality-adjusted life year (QALY). ESS with EFS compared to ESS without EFS yielded an ICER of $62,310/QALY. At a willingness-to-pay (WTP) threshold of $50,000/QALY, ESS without EFS was more cost-effective than ESS with EFS with 52.1% certainty. These results were robust to one-way analysis and probabilistic sensitivity analysis. CONCLUSIONS ESS remains a cost-effective intervention compared to medical therapy alone for patients with CRSwNP. In this study, the addition of frontal sinusotomy during ESS for patients with CRSwNP was not found to be cost-effective at a WTP threshold of $50,000/QALY, but may be cost effective at a higher threshold of $100,000/QALY. LEVEL OF EVIDENCE 2c. Laryngoscope, 128:43-51, 2018.
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Affiliation(s)
- George A Scangas
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Ashton E Lehmann
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Aaron K Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Brooke M Su
- School of Medicine, University of California-San Francisco, San Francisco, California, U.S.A
| | - Mark G Shrime
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
| | - Ralph Metson
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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Scangas GA, Remenschneider AK, Su BM, Shrime MG, Metson R. Cost utility analysis of endoscopic sinus surgery for chronic rhinosinusitis with and without nasal polyposis. Laryngoscope 2016; 127:29-37. [PMID: 27440486 DOI: 10.1002/lary.26169] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 05/16/2016] [Accepted: 06/07/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of endoscopic sinus surgery (ESS) compared to medical therapy for patients with chronic rhinosinusitis (CRS) with and without nasal polyposis (NP). STUDY DESIGN Cohort-style Markov decision-tree economic model with a 36-year time horizon. METHODS Two cohorts of 229 CRS patients with and without NP who underwent ESS were compared with a matched cohort of 229 CRS patients from the Medical Expenditures Survey Panel database (Agency for Healthcare Research and Quality, Rockville, MD) who underwent medical management. Utility scores were calculated from sequential patient responses to the EuroQol five-dimensions questionnaire. Decision-tree analysis and a 10-state Markov model utilized published event probabilities and primary data to calculate long-term costs and utility. The primary outcome was the incremental cost per quality-adjusted life year (QALY). Thorough sensitivity analyses were performed. RESULTS The reference case for CRS with NP yielded an incremental cost-effectiveness ratio (ICER) for ESS versus medical therapy of $5,687.41/QALY. The reference case for CRS without NP yielded an ICER of $5,405.44/QALY. The cost-effectiveness acceptability curve in both cases demonstrated 95% certainty that the ESS strategy was the most cost-effective option at a willingness-to-pay threshold of $20,000/QALY or higher. These results were robust to one-way and probabilistic sensitivity analysis. CONCLUSION This study demonstrates the cost-effectiveness of ESS compared to medical therapy alone for the management of CRS patients both with and without NP. The presence of nasal polyps was not found to affect the overall cost-effectiveness of ESS. LEVEL OF EVIDENCE 2C. Laryngoscope, 127:29-37, 2017.
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Affiliation(s)
- George A Scangas
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Aaron K Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Brooke M Su
- School of Medicine, University of California-San Francisco, San Francisco, California, U.S.A
| | - Mark G Shrime
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Ralph Metson
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
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Scangas GA, Su BM, Remenschneider AK, Shrime MG, Metson R. Cost utility analysis of endoscopic sinus surgery for chronic rhinosinusitis. Int Forum Allergy Rhinol 2016; 6:582-9. [DOI: 10.1002/alr.21697] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 12/28/2022]
Affiliation(s)
- George A. Scangas
- Department of Otology and Laryngology; Harvard Medical School; Boston MA
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston MA
| | - Brooke M. Su
- School of Medicine; University of California, San Francisco; San Francisco CA
| | - Aaron K. Remenschneider
- Department of Otology and Laryngology; Harvard Medical School; Boston MA
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston MA
| | - Mark G. Shrime
- Department of Otology and Laryngology; Harvard Medical School; Boston MA
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston MA
- Program in Global Surgery and Social Change; Harvard Medical School; Boston MA
| | - Ralph Metson
- Department of Otology and Laryngology; Harvard Medical School; Boston MA
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston MA
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Chen EQ, Bai L, Chen LL, Zhou TY, Du LY, Tang H. Prolonged Combination Therapy is More Effective than Monotherapy in Management of Chronic Hepatitis B Patients With Sustained Virological Response: An Experience From a 'Real-World' Clinical Setting. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e7788. [PMID: 24693412 PMCID: PMC3955527 DOI: 10.5812/ircmj.7788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 09/25/2013] [Accepted: 10/29/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little is known about the duration of combination therapy for patients with chronic hepatitis B (CHB) and suboptimal response to nucleos(t)ide analogues(NAs) monotherapy. OBJECTIVES This study aimed to assess whether monotherapy could be used for treatment of CHB patients, who poorly responded to Adefovir Dipivoxil (ADV) but obtained good responses after at least 12-month lamivudine (LAM) or telbivudine (LdT) add-on therapy. PATIENTS AND METHODS Forty-five patients were enrolled, and the baseline time-point was determined according to enrollment data. Twenty-six patients chose to continue combination therapy (LAM+ADV or LdT+ADV, Group A) and 19 patients switched to single-drug maintenance therapy (LAM or LdT or ADV, Group B). RESULTS There were no significant differences between two groups in baseline characteristics (P > 0.05). At 12th month, sustained virological response rate was greater in group A compared to group B (96.2% vs. 47.4%, P < 0.001), and the rates of NAs-associated resistance were 0% in group A and 15.8% in group B. Alanine aminotransferase normalization rate was also significantly higher in group A compared with group B (92.3% vs. 36.8%, P < 0.001). Among hepatitis positive patients with Be antigen (HBeAg)-, 40% (4/10) in group A and 9.1% (1/11) in group B achieved HBeAg seroconversion at the 12th month. Of patients in group B with positive-HBeAg before the previous combination therapy and detectable HBV DNA at 6 months of previous combination therapy were associated with high risks of viral relapse after switching to single-drug maintenance therapy. CONCLUSIONS Prematurely switching to single-drug maintenance therapy would be resulted in viral relapse, and prolonged combination therapy was effective to maintain sustained responses for patients with initial suboptimal response to ADV.
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Affiliation(s)
- En Qiang Chen
- Center of Infectious Diseases, West China Hospital, Sichuan University, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China
| | - Lang Bai
- Center of Infectious Diseases, West China Hospital, Sichuan University, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China
| | - Lan Lan Chen
- Center of Infectious Diseases, West China Hospital, Sichuan University, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China
| | - Tao You Zhou
- Center of Infectious Diseases, West China Hospital, Sichuan University, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China
| | - Ling Yao Du
- Center of Infectious Diseases, West China Hospital, Sichuan University, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital, Sichuan University, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Sichuan University, China
- Corresponding Author: Hong Tang, Center of Infectious Diseases, West China Hospital, Sichuan University, China. Tel: + 86-2885422650, E-mail:
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Abstract
Objectives: We studied the cost-effectiveness of tenofovir and entecavir in e antigen positive (CHBe+) and negative (CHBe-) chronic hepatitis B.Methods: Using a multicenter survey including 544 patients we measured patient quality of life and attributable costs by clinical disease stage. Natural disease progression was studied in 278 patients in a single center. A Markov model was constructed to follow hypothetical cohorts of treated and untreated 40-year-old CHBe+ and CHBe- patients and 50-year-old patients with compensated cirrhosis.Results: We did not find an improvement in quality of life when viral load was reduced under treatment. Transition rates to liver cirrhosis were found to be age-dependent. Assuming equal effectiveness, tenofovir dominates the entecavir strategy because of its lower price in Belgium. The incremental cost-effectiveness ratio (ICER) of tenofovir after 20 years is more favorable for treating Caucasian cirrhotic patients (mean ICER €29,000/quality-adjusted life-year [QALY]) compared with treating non-cirrhotic patients (mean ICER €110,000 and 131,000/QALY for CHB e+ and e-, respectively). Within the non-cirrhotic patients the ICER decreases with increasing cohort starting age from 30 to 50 years.Conclusions: Results of long-term models for tenofovir or entecavir treatment of CHB need to be interpreted with caution as long-term trials with hard end points are lacking. Especially the effect on HCC remains highly uncertain. Based on cost-effectiveness considerations such antiviral treatment should be targeted at patients with cirrhosis or at risk of rapid progression to this disease stage.
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Miyauchi T, Kanda T, Shinozaki M, Kamezaki H, Wu S, Nakamoto S, Kato K, Arai M, Mikami S, Sugiura N, Kimura M, Goto N, Imazeki F, Yokosuka O. Efficacy of lamivudine or entecavir against virological rebound after achieving HBV DNA negativity in chronic hepatitis B patients. Int J Med Sci 2013; 10:647-52. [PMID: 23569428 PMCID: PMC3619113 DOI: 10.7150/ijms.5904] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/27/2013] [Indexed: 12/20/2022] Open
Abstract
Nucleos(t)ide analogues (NAs) lead to viral suppression and undetectable hepatitis B virus (HBV) DNA in some individuals infected with HBV, but the rate of virological rebound has been unknown in such patients. We examined the prevalence of virological rebound of HBV DNA among NA-treated patients with undetectable HBV DNA. We retrospectively analyzed 303 consecutive patients [158 entecavir (ETV)- and 145 lamivudine (LAM)-treated] who achieved HBV DNA negativity, defined as HBV DNA < 3.7 log IU/mL for at least 3 months. They were followed up and their features, including their rates of viral breakthrough, were determined. Viral rebound after HBV DNA negativity was not observed in the ETV-group. Viral rebound after HBV DNA negativity occurred in 38.7% of 62 HBe antigen-positive patients in the LAM-group. On multivariate analysis, age was an independent factor for viral breakthrough among these patients (P = 0.035). Viral rebound after HBV DNA negativity occurred in 29.1% of 79 HBe antigen-negative patients in the LAM-group. Differently from LAM, ETV could inhibit HBV replication once HBV DNA negativity was achieved. In contrast, LAM could not inhibit HBV replication even if HBV negativity was achieved in the early phase. Attention should be paid to these features in clinical practice.
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Affiliation(s)
- Tomoo Miyauchi
- Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, Chiba 260-8677, Japan
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Lui YYN, Tsoi KKF, Wong VWS, Kao JH, Hou JL, Teo EK, Mohamed R, Piratvisuth T, Han KH, Mihm U, Wong GLH, Chan HLY. Cost-effectiveness analysis of roadmap models in chronic hepatitis B using tenofovir as the rescue therapy. Antivir Ther 2010; 15:145-55. [PMID: 20386069 DOI: 10.3851/imp1496] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND The roadmap approach is recommended to guide chronic hepatitis B treatment. We evaluated the cost-effectiveness of various treatment strategies in the global market. METHODS Lamivudine and telbivudine were tested in roadmap models with switch-to tenofovir if HBV was detectable at week 24 or add-on tenofovir if resistance developed at year 1. Tenofovir and entecavir were tested as continuous monotherapy. In the reference arm, lamivudine was used with add-on tenofovir if resistance developed at year 1. The primary measure of effectiveness was undetectable HBV DNA at year 2. Cost-effectiveness was measured by incremental cost-effectiveness ratio (ICER) in US dollars against the reference arm. RESULTS In the US and Germany, costs of the reference arms were US $14,486 and US $9,998 for hepatitis B e antigen (HBeAg)-positive and US $11,398 and US $7,531 for HBeAg-negative patients, respectively. In HBeAg-positive patients, the lamivudine roadmap was most cost-effective (ICER US $15,260 in the US and US $29,113 in Germany) with comparable effectiveness (75.1%) to other strategies. In HBeAg-negative patients, tenofovir and entecavir monotherapies were most effective (91-96%) and cost-effective (ICER US $31,297-43,387 in the US and US $53,976-59,822 in Germany). In Asia, where telbivudine cost was lower, both telbivudine and lamivudine roadmaps were cost-effective in HBeAg-positive patients. Tenofovir would be most cost-effective in HBeAg-negative patients if its cost equaled that of telbivudine in Asia. CONCLUSIONS In HBeAg-positive patients, lamivudine roadmap was most cost-effective; in Asia, telbivudine roadmap had comparable cost-effectiveness to lamivudine roadmap because of the relatively low price of telbivudine. In HBeAg-negative patients, entecavir and tenofovir monotherapies were more cost-effective than the roadmap models.
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Affiliation(s)
- Yanni Yan-Ni Lui
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, New Terrritories, Hong Kong
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Abstract
Peginterferon-alpha-2a (40 kD) [Pegasys] comprises an inert, branched, 40 kD polyethylene glycol (PEG) moiety attached to interferon-alpha-2a. Subcutaneous peginterferon-alpha-2a (40 kD) is indicated for the treatment of adults with hepatitis B e antigen (HBeAg)-positive or -negative chronic hepatitis B who have compensated liver disease with evidence of viral replication and hepatic inflammation. Subcutaneous peginterferon-alpha-2a (40 kD) has antiviral and immunomodulatory properties and a convenient once-weekly administration schedule. Forty-eight weeks of therapy with peginterferon-alpha-2a (40 kD) with or without lamivudine was more effective than lamivudine alone in achieving a sustained response in patients with HBeAg-positive or -negative chronic hepatitis B. A long-term follow-up study in patients with HBeAg-positive disease who received peginterferon-alpha-2a (40 kD) monotherapy revealed an HBeAg seroconversion rate of 42%, 1 year after the end of treatment. A long-term follow-up study in patients with HBeAg-negative disease who received peginterferon-alpha-2a (40 kD) with or without lamivudine revealed hepatitis B surface antigen (HBsAg) clearance in 12% of patients and inactive chronic hepatitis B in 17% of patients, 5 years after the end of treatment. Various predictors of response may be useful in terms of identifying patients who may be candidates for shorter or longer peginterferon-alpha-2a (40 kD) treatment durations. For example, quantifying serum HBeAg (in HBeAg-positive disease) and HBsAg levels during therapy may be useful. Adverse events typical of the influenza-like symptoms seen with alpha-interferons occurred more frequently in patients with chronic hepatitis B receiving peginterferon-alpha-2a (40 kD) with or without lamivudine than in those receiving lamivudine alone. In conclusion, peginterferon-alpha-2a (40 kD) is a valuable option for the first-line treatment of HBeAg-negative or -positive chronic hepatitis B.
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Wang LC, Chen EQ, Cao J, Liu L, Wang JR, Lei BJ, Tang H. Combination of Lamivudine and adefovir therapy in HBeAg-positive chronic hepatitis B patients with poor response to adefovir monotherapy. J Viral Hepat 2010; 17:178-84. [PMID: 19656287 DOI: 10.1111/j.1365-2893.2009.01164.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
At present, there is no consensus treatment for patients who have poor response to Adevofir dipivoxil (ADV) monotherapy and no ADV-associated mutation. The purpose of this study was to evaluate the effect of a new therapeutic strategy combining Lamivudine (LAM) and ADV in patients with HBeAg-positive chronic hepatitis B (CHB) and poor response to ADV monotherapy. Thirty-one patients with chronic hepatitis B with HBV DNA > or = 10(4) copies/mL after 48 weeks of ADV monotherapy were included and received ADV plus LAM for 24 weeks. Compared with ADV monotherapy, ADV + LAM had an improved response rate at weeks 12 and 24 - compared with baseline, the median decrease in HBV-DNA level at week 12 and 24 were 1.27 and 2.03 log respectively. The virological response (VR) rate (HBV-DNA level <10(3) copies/mL) was 6.5% and 35.5% at weeks 12 and 24, respectively; the biochemical response (BR) rate (normalization of alanine aminotransferase levels) was 67.8% and 100%, respectively; the HBeAg loss rate was 6.9% and 34.5%, respectively; and the seroconversion rate (from HBeAg to HBeAb) was 3.5% and 6.9% respectively. No ADV-associated mutation was detected at baseline. After combination therapy for 24 weeks, no LAM-resistant or ADV-resistant mutations were detected. Only one patient had a mild adverse reaction. In conclusion, optimization of therapy combining LAM and ADV may be a good choice for patients with hepatitis B who have a poor response to ADV monotherapy.
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Affiliation(s)
- L-C Wang
- Center of Infectious Diseases, Division of Molecular Biology of Infectious Diseases, State Key Laboratory of Biotherapy (Sichuan University), West China Hospital, Sichuan University, Chengdu, Sichuan, China
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