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Cost-Effectiveness and Cost Thresholds of Generic and Brand Drugs in a National Chronic Hepatitis B Treatment Program in China

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  • Mehlika Toy
  • David W Hutton
  • Samuel K So

Abstract

Chronic liver disease and liver cancer associated with chronic hepatitis B (CHB) are leading causes of death among adults in China. Although newborn hepatitis B immunization has successfully reduced the prevalence of CHB in children, about 100 million Chinese adults remain chronically infected. If left unmanaged, 15–25% will die from liver cancer or liver cirrhosis. Antiviral treatment is not necessary for all patients with CHB, but when it is indicated, good response to treatment would prevent disease progression and reduce disease mortality and morbidity, and costly complications. The aim of this study is to analyze the cost-effectiveness of generic and brand antiviral drugs for CHB treatment in China, and assessing various thresholds at which a highly potent, low resistance antiviral drug would be cost-saving and/or cost-effective to introduce in a national treatment program. We developed a Markov simulation model of disease progression using effectiveness and cost data from the medical literature. We measured life-time costs, quality adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and clinical outcomes. The no treatment strategy incurred the highest health care costs ($12,932-$25,293) per patient, and the worst health outcomes, compared to the antiviral treatment strategies. Monotherapy with either entecavir or tenofovir yielded the most QALYs (14.10–19.02) for both HBeAg-positive and negative patients, with or without cirrhosis. Threshold analysis showed entercavir or tenofovir treatment would be cost saving if the drug price is $32–75 (195–460 RMB) per month, highly cost-effective at $62–110 (379–670 RMB) per month and cost-effective at $63–120 (384–734 RMB) per month. This study can support policy decisions regarding the implementation of a national health program for chronic hepatitis B treatment in China at the population level.

Suggested Citation

  • Mehlika Toy & David W Hutton & Samuel K So, 2015. "Cost-Effectiveness and Cost Thresholds of Generic and Brand Drugs in a National Chronic Hepatitis B Treatment Program in China," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-19, November.
    • Handle: RePEc:plo:pone00:0139876
    DOI: 10.1371/journal.pone.0139876
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    References listed on IDEAS

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    1. Weixia Ke & Li Liu & Chi Zhang & Xiaohua Ye & Yanhui Gao & Shudong Zhou & Yi Yang, 2014. "Comparison of Efficacy and Safety of Tenofovir and Entecavir in Chronic Hepatitis B Virus Infection: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 9(6), pages 1-8, June.
    2. Rachael Fleurence & Christopher Hollenbeak, 2007. "Rates and Probabilities in Economic Modelling," PharmacoEconomics, Springer, vol. 25(1), pages 3-6, January.
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    Cited by:

    1. Kristen Scheckelhoff & Ayesha Ejaz & Igor V. Erovenko & Jan Rychtář & Dewey Taylor, 2021. "Optimal Voluntary Vaccination of Adults and Adolescents Can Help Eradicate Hepatitis B in China," Games, MDPI, vol. 12(4), pages 1-13, October.
    2. Yi-Jun Liu & Adam Keane & Kate T Simms & Jie-Bin Lew & Ju-Fang Shi & Carolyn Mazariego & Susan Yuill & Jose Jeronimo & You-Lin Qiao & Karen Canfell, 2019. "Development and application of a framework to estimate health care costs in China: The cervical cancer example," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-13, October.

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