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Lamivudine Compared With Newer Antivirals for Prophylaxis of Hepatitis B Core Antibody Positive Livers: A Cost‐Effectiveness Analysis
Author(s) -
Wright A. J.,
Fishman J. A.,
Chung R. T.
Publication year - 2014
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.12598
Subject(s) - lamivudine , entecavir , medicine , emtricitabine , hepatitis b , hepatitis b virus , virology , virus
There is concern over the development of de novo hepatitis B in patients receiving liver transplants from hepatitis B surface antigen negative, hepatitis B core antibody positive donors. Current practice is to place such patients on indefinite lamivudine prophylaxis; however, there is a small risk of breakthrough infection and newer antivirals for hepatitis B are available. The objective of this study was to determine the cost‐effectiveness of lamivudine compared with the newer agents, tenofovir and entecavir, in the prophylaxis setting using a Markov model. Three strategies were examined which consisted of either lamivudine or entecavir monoprophylaxis with tenofovir add‐on therapy after breakthrough or tenofovir monoprophylaxis with emtricitabine add‐on therapy after breakthrough. In the base case scenario, lamivudine was the most cost‐effective option at a threshold of $100 000 per quality‐adjusted life‐year and this remained robust despite parameter uncertainty. Tenofovir had an incremental cost‐effectiveness ratio of $3 540 194.77 while other strategies were superior to entecavir therapy. Until drug costs decrease, lamivudine remains the most cost‐effective option for hepatitis B prophylaxis in the liver transplant setting.