Cost-Utility Analysis of Tenofovir Disoproxil Fumarate in the Treatment of Chronic Hepatitis B

Objective: The aim of this study was to assess the cost-effectiveness of tenofovir disoproxil fumarate (TDF) in the treatment of chronic hepatitis B (CHB) versus alternative nucleos(t)ides from a UK National Health Service (NHS) perspective. Methods: A Markov model was used to calculate costs and benefits of nucleos(t)ide strategies in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients with hepatitis B virus mono-infection and compensated liver disease. The model included 18 disease states representing CHB progression. Quality-of-life data and costs for severe disease states were based on published studies, while monitoring costs for other disease states were based on expert opinion. Transition probabilities for movements between states were based on a meta-analysis, clinical trials, and natural history studies. Results: First-line TDF generated the highest net benefits of all 211 nucleos(t)ide strategies evaluated at a threshold of 20,000 pound per quality-adjusted life-year (QALY) gained. First-line TDF cost 19,084 pound/QALY gained compared with giving lamivudine (LAM) first-line and switching to TDF when LAM resistance occurs. First-line TDF was also more effective and less costly than first-line entecavir (ETV), and showed extended dominance over first-line adefovir and strategies reserving adefovir, ETV, or combination therapy until after LAM resistance develops. For patients who have developed LAM resistance, TDF was also the most cost-effective treatment, generating greater net benefits than any other second-line strategy. Conclusions: First-line TDF is the most cost-effective treatment for patients with CHB at a 20,000 pound to 30,000 pound/QALY ceiling ratio, costing 19,084 pound/QALY gained compared with the next best alternative.