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Jim Butler Australian National University

Cost/benefit of hepatitis B treatment A presentation at the 14th National Symposium on Hepatitis B and C St Vincent’s Hospital Melbourne Saturday,18 November 2006. Jim Butler Australian National University. Overview. Two components Cost of treating hepatitis B patients

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Jim Butler Australian National University

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  1. Cost/benefit of hepatitis B treatmentA presentation at the14th National Symposium on Hepatitis B and CSt Vincent’s HospitalMelbourneSaturday,18 November 2006 Jim Butler Australian National University

  2. Overview Two components • Cost of treating hepatitis B patients • Cost-effectiveness of alternative therapies

  3. Cost of treating hepatitis B patients The Direct Cost of Managing Patients With Chronic Hepatitis B Infection in Australia Journal of Clinical Gastroenterology, 38 (Supp.3), Nov/Dec 2004, pp.S187-S192. James RG Butler, BEcon MPolEcon PhD Stephen Pianko, MBBS FRACP PhD Rosemary J. Korda, BAppSci MAppSci GradDipPopHlth Shara Nguyen, BSc Paul J. Gow, MBBS FRACP PhD Stuart K. Roberts, MBBS FRACP MD Simone I. Strasser, MBBS FRAC, MD William Sievert, MBBS FRACP MD

  4. Retrospective analysis - 149 patients - six disease states:- non-cirrhotic CHB- compensated cirrhosis- decompensated cirrhosis- hepatocellular carcinoma- liver transplantation in year 1- liver transplantation in subsequent years Cost of palliative care - 53 patients - chronic hepatitis and hepatocellular carcinoma - data from palliative care unit.

  5. Demographic characteristics of sample

  6. 1-year costs of managing hep B patients

  7. LOS and cost per patient – institutionalised palliative care for HCC

  8. Cost-effectiveness analysis Treatment Alternatives for Chronic Hepatitis B Virus Infection: A Cost-Effectiveness Analysis Annals of Internal Medicine, 142(10), May 2005, pp.821-31. Kanwal et al

  9. Treatment strategies 1) No HBV treatment (“do nothing” strategy) 2) interferon monotherapy 3) lamivudine monotherapy 4) adefovir monotherapy 5) lamivudine with crossover to adefovir upon resistance (“adefovir salvage” strategy)

  10. Results • The “do nothing” strategy was least effective yet least expensive • Compared with the “do nothing” strategy, using interferon cost an incremental $6337 to gain 1 additional QALY. • Compared with interferon, the adefovir salvage strategy cost an incremental $8446 per QALY gained. • Both the lamivudine and adefovir monotherapy strategies were more expensive yet less effective than the alternative strategies and were therefore dominated.

  11. Caveats • Lamivudine resistance may compromise efficacy of new nucleoside analogue (Entecavir) – analysis does take adequate account of problems of lamivudine resistence (Weitzman et al 2005) • The findings apply only to patients with persistently elevated aminotransferase levels and no cirrhosis. • The authors did not model the cost-effectiveness of nucleoside analogue salvage after interferon therapy failure

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