Cost-effectiveness and cost-utility of the treatment of chronic hepatitis B with peginterferon alfa-2a, interferon alfa, and lamivudine in Lithuania

Background. Chronic hepatitis B infection is an important health care problem worldwide. According to the World Health Organization, 10% to 15% of population is infected with hepatitis B virus. Nearly 100 new cases of acute hepatitis B are annually registered in Lithuania, but official statistics covers only 8–25% of all disease incidence. The aim of this study was to evaluate the cost-effectiveness of the treatment of chronic hepatitis B with peginterferon alfa-2a and compare it to treatment with interferon alfa and lamivudine in Lithuania.
Material and methods. A Markov model was used to evaluate long-term cost-effectiveness of the treatment with peginterferon alfa-2a and to compare it with treatment with interferon alfa and lamivudine. Peginterferon alfa-2a was administered by subcutaneous injections at a dosage of 180 μg every week for 48 weeks; interferon alfa, 6 million IU three times a week for 24 weeks; and lamivudine, 100 mg per day from 48 weeks to 5 years for HBeAg-positive chronic hepatitis B and 100 mg per day up to 5 years in HBeAg-negative chronic hepatitis B.
Results. Treatment with peginterferon alfa-2a gained 1.179 life years as compared to 0.658 life years gained with treatment with interferon alfa; incremental costs per incremental life-year gained (LYG) were 51 256.92 Lt (14 845.03 €). Treatment with peginterferon alfa-2a gained 0.545 quality-adjusted life-years (QALYs) with incremental costs per incremental QALY of 48 980.08 Lt (14 185.61 €). Treatment with peginterferon alfa-2a had twice higher cost-effectiveness than treatment with interferon alfa: 50 4167.00 Lt (146 016.85 €) vs. 954 020.08 Lt (276 303.31 €), respectively. Costs for a complete response were also twice lower. Treatment with peginterferon alfa-2a gained 0.757 incremental LYG more compared to lamivudine (48-week course). Comparing incremental cost-effectiveness using peginterferon alfa-2a for treatment, incremental costs per incremental LYG were 41 993.67 Lt (12 162.21 €); additionally there was a gain of 0.792 incremental QALYs, while incremental costs for incremental QALY were 40 096.19 Lt (11 612.66 €). Complete response costs were 83 515.98 Lt (24 187.89 €) less compared to lamivudine (48-week course).
Conclusions. Treatment of chronic hepatitis B prolongs patients’ overall survival and qualityadjusted life. Peginterferon alfa-2a was the most effective drug registered in Lithuania for CHB treatment.