Evaluation of lamivudine and adefovir dipivoxil monoterapies from cost-effectiveness point of view in naive patients with chronic hepatitis B.

Introduction and Aim: Chronic hepatitis B (CHB) virus infection is common, with an estimated global prevalence of more than 400 million people. Patients with CHB and evidence of ongoing viral replication have a high risk of serious liver disease. Pharmacoeconomic studies can help in decision-making to optimize resources especially in social and health fields. The aim of this study was to perform cost-effectiveness of long-term therapy with adefovir dipivoxil and lamivudine in patients with CHB.Material and Method: A decision analysis model was used to perform a cost-effectiveness analysis of lamivudine and adefovir dipivoxil. The treatment-related costs and effectiveness of the two oral therapies were assessed in a cohort of 100 patients with CHB. Data were obtained from clinical trials.Results: For the base-case, the total estimated cost per patient treated with lamivudine or adefovir dipivoxil for four years was YTL19.477 and YTL37.296 respectively. Virological response at the end of year four was 40% for the lamivudine arm and 81% for the adefovir dipivoxil arm. The average cost-effectiveness ratio was YTL48.693 for the lamivudine arm and YTL46.044 for the adefovir dipivoxil arm (p=0.045). The incremental cost-effectiveness ratio of adefovir dipivoxil versus lamivudine was YTL43.461, indicating that this cost was slightly lower than the average cost-effectiveness ratios of adefovir dipivoxil or lamivudine. The sensitivity analysis demonstrated that the response to the therapy at the end of the fourth year was an important factor in determining the cost-effectiveness.Conclusion: From pharmacoeconomical point of view, long-term treatment with adefovir dipivoxil is a cost-effective strategy in patients with CHB.