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Economic Evaluation of Oral Nucleos(t)ide Analogues for Patients with Chronic Hepatitis B in Thailand

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Abstract

Background

Nucleos(t)ide analogues (NAs) are the main drug category used in the treatment of chronic hepatitis B (CHB). There is a need to update the economic evaluation of CHB treatment.

Objective

This study aimed to determine the cost effectiveness of NAs for CHB in Thailand.

Method

We used a lifetime Markov model undertaken from a societal perspective. Tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF), entecavir (ETV) with TDF or TAF as rescue medications, and lamivudine (LAM) with TDF or TAF rescue medications were compared with best supportive care (BSC). We performed a network meta-analysis to estimate the treatment effects of each NA on hepatitis B surface antigen (HBsAg) loss in an Asian population and performed an additional literature review to identify inputs. We calculated incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-years (QALYs) and performed sensitivity analyses.

Results

Compared with BSC, all NAs could improve patients’ QALYs, with results ranging from 4.04 to 4.25 QALYs gained. TAF, TDF, LAM/TAF, and LAM/TDF yielded lower total lifetime costs than BSC, ranging from − $US1387 to − 814, whereas ETV/TAF and ETV/TDF yielded higher total lifetime costs than BSC, ranging from $US4965 to 4971. The ICER was $US1230/QALY for ETV/TDF and $US1228/QALY for ETV/TAF. Full incremental analysis showed that the ICER for LAM/TAF was $US1720/QALY compared with TAF.

Conclusion

At current prices, TAF, TDF, LAM/TAF, and LAM/TDF are dominant options, and ETV/TAF or ETV/TDF are cost-effective options. LAM/TAF is the most cost-effective option, followed by TAF.

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Acknowledgements

The authors acknowledge the Center of Excellence in Hepatitis and Liver Cancer, Faculty of Medicine, Chulalongkorn University.

Author information

Authors and Affiliations

  1. Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Mueang Phitsanulok, Thailand

    Piyameth Dilokthornsakul

  2. Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand

    Pajaree Sriuttha & Unchalee Permsuwan

  3. Clinical Trial and Evidence-Based Synthesis Research Cluster , Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand

    Ratree Sawangjit

  4. Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Pisit Tangkijvanich

  5. Alternative and Complementary Medicine for Gastrointestinal and Liver Diseases Research Unit, Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

    Maneerat Chayanupatkul

  6. Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Tawesak Tanwandee

  7. Liver Disease Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Wattana Sukeepaisarnjaroen

Authors
  1. Piyameth Dilokthornsakul
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Corresponding author

Correspondence to Piyameth Dilokthornsakul.

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Conflict of interest

Piyameth Dilokthornsakul, Ratree Sawangjit, Pisit Tangkijvanich, Maneerat Chayanupatkul, Tawesak Tanwandee,Wattana Sukeepaisarnjaroen, Pajaree Sriuttha, Unchalee Permsuwan have no conflicts of interest that are directly relevant to the content of this article.

Funding

This study was funded by the Thai Association of the Study of the Liver and the Thailand Research Fund (TRF) Senior Research Scholar (RTA6280004). The funders had no role in any process in the conduct of this study.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Models used in the current study are available from the corresponding author on reasonable request.

Author contributions

Piyameth Dilokthornsakul, Maneerat Chayanupatkul, and Unchalee Permsuwan: study design, data collection, data analysis, manuscript preparation. Ratree Sawangjit: study design, data collection, manuscript preparation. Pisit Tangkijvanich and Tawesak Tanwandee: study design, data analysis, manuscript preparation. Wattana Sukeepaisarnjaroen and Pajaree Sriuttha: study design, data collection. All authors provided final approval of the manuscript.

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Dilokthornsakul, P., Sawangjit, R., Tangkijvanich, P. et al. Economic Evaluation of Oral Nucleos(t)ide Analogues for Patients with Chronic Hepatitis B in Thailand. Appl Health Econ Health Policy 20, 587–596 (2022). https://doi.org/10.1007/s40258-022-00719-y

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  • DOI: https://doi.org/10.1007/s40258-022-00719-y

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