The cost‐effectiveness of long‐term antiviral therapy in the management of HBeAg‐positive and HBeAg‐negative chronic hepatitis B in Singapore

Summary.  The purpose of this study was the economic evaluation of short‐duration treatments of chronic hepatitis B (CHB) and longer duration antiviral treatment for up to 5 years. Two 10‐health state Markov models were developed for hepatitis B e antigen (HBeAg)‐positive and HBeAg‐negative CHB patients respectively. The perspective of this economic evaluation was the Singapore healthcare system and CHB patient. The models followed cohorts of HBeAg‐positive and HBeAg‐negative CHB patients, respectively, over a period of 40 years, by which time the majority of the cohorts would have died if left untreated. Costs and benefits were discounted at 5% per annum. Annual rates of disease progression and the magnitude of treatment effects were obtained from the literature, with a focus on data obtained in Asian patients and meeting the criteria for therapy as described in internationally recognized management guidelines. Short‐course therapy with α ‐interferon, or 1‐year treatment with pegylated interferon α ‐2a, lamivudine or adefovir had limited impact on disease progression. In contrast, treatment of CHB with antiviral therapy for 5 years substantially decreased the rate of disease progression. Treatment with lamivudine for 1‐year is highly cost‐effective compared with no treatment of CHB but has limited effect on reducing the rate of disease progression. Compared with 1‐year treatment with lamivudine, sequential antiviral therapies for up to 5 years (i.e. lamivudine plus adefovir on emergence of lamivudine resistance or adefovir plus lamivudine on emergence of adefovir resistance) are highly cost‐effective by international standards. These conclusions are robust to uncertainties in model inputs and are consistent with the findings of other recently published studies.