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A Cost-Utility and Cost-Effectiveness Analysis of Different Oral Antiviral Medications in Patients With HBeAg-Negative Chronic Hepatitis B in Iran: An Economic Microsimulation Decision Model

Khosro Keshavarz 1 , Abbas Kebriaeezadeh 2 , Seyed Moayed Alavian 3 , Ali Akbari Sari 4 , Mohsen Rezaei Hemami 5 , Farhad Lotfi 1 , Amir Hashemi Meshkini 2 , Mehdi Javanbakht 6 , Maryam Keshvari 7 and Shekoufeh Nikfar 2 , *
Authors Information
1 Health Human Resource Research Center, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran
2 Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
3 Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
4 Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, IR Iran
5 Institute of Health & Wellbeing, Health Economics & Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
6 Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
7 Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, IR Iran
Article information
  • Hepatitis Monthly: September 01, 2016, 16 (9); e37435
  • Published Online: August 14, 2016
  • Article Type: Research Article
  • Received: February 28, 2016
  • Revised: July 2, 2016
  • Accepted: August 7, 2016
  • DOI: 10.5812/hepatmon.37435

To Cite: Keshavarz K, Kebriaeezadeh A, Alavian S M, Akbari Sari A, Rezaei Hemami M, et al. A Cost-Utility and Cost-Effectiveness Analysis of Different Oral Antiviral Medications in Patients With HBeAg-Negative Chronic Hepatitis B in Iran: An Economic Microsimulation Decision Model, Hepat Mon. 2016 ; 16(9):e37435. doi: 10.5812/hepatmon.37435.

Copyright © 2016, Kowsar Corp. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Lok AS. Chronic hepatitis B. N Engl J Med. 2002; 346(22): 1682-3[DOI][PubMed]
  • 2. Alavian SM, Fallahian F, Lankarani KB. The changing epidemiology of viral hepatitis B in Iran. J Gastrointestin Liver Dis. 2007; 16(4): 403-6[PubMed]
  • 3. Lee WM. Hepatitis B virus infection. N Engl J Med. 1997; 337(24): 1733-45[DOI][PubMed]
  • 4. Lai CL. Chronic hepatitis B in Hong Kong: immunization strategies for the control of hepatitis B virus infection. Hepatitis B Asian-Pacific region. 1997; 1: 79-87
  • 5. Keshavarz K, Kebriaeezadeh A, Alavian SM, Akbari Sari A, Abedin Dorkoosh F, Keshvari M, et al. Economic burden of hepatitis B virus-related diseases: evidence from iran. Hepat Mon. 2015; 15(4): 25854[DOI][PubMed]
  • 6. Alavian SM, Hajarizadeh B, Ahmadzad-Asl M, Kabir A, Bagheri-Lankarani K. Hepatitis B Virus infection in Iran: A systematic review. Hepat Mon. 2008; 8(4): 281-94
  • 7. 2015;
  • 8. Alavian SM, Keyvani H, Rezai M, Ashayeri N, Sadeghi HM. Preliminary report of hepatitis B virus genotype prevalence in Iran. World J Gastroenterol. 2006; 12(32): 5211-3[PubMed]
  • 9. Haghshenas MR, Arabi M, Mousavi T. Hepatitis B genotypes in iran. Mater Sociomed. 2014; 26(2): 129-33[DOI][PubMed]
  • 10. Mohamadnejad M, Montazeri G, Fazlollahi A, Zamani F, Nasiri J, Nobakht H, et al. Noninvasive markers of liver fibrosis and inflammation in chronic hepatitis B-virus related liver disease. Am J Gastroenterol. 2006; 101(11): 2537-45[DOI][PubMed]
  • 11. Sherman M, Shafran S, Burak K, Doucette K, Wong W, Girgrah N, et al. Management of chronic hepatitis B: consensus guidelines. Can J Gastroenterol. 2007; 21 Suppl C: 5-24[PubMed]
  • 12. He J, Bowen JM, Xie F, Goeree R. Cost-effectiveness analysis of antiviral treatments for HBeAg-positive chronic hepatitis B in Canada. Value Health. 2012; 15(6): 894-906[DOI][PubMed]
  • 13. Dakin H, Bentley A, Dusheiko G. Cost-utility analysis of tenofovir disoproxil fumarate in the treatment of chronic hepatitis B. Value Health. 2010; 13(8): 922-33[DOI][PubMed]
  • 14. Yuan Y, Iloeje UH, Hay J, Saab S. Evaluation of the cost-effectiveness of entecavir versus lamivudine in hepatitis BeAg-positive chronic hepatitis B patients. J Manag Care Pharm. 2008; 14(1): 21-33[DOI][PubMed]
  • 15. Earnshaw J, Lewis G. NICE Guide to the Methods of Technology Appraisal: pharmaceutical industry perspective. Pharmacoeconomics. 2008; 26(9): 725-7[PubMed]
  • 16. Wiens A, Venson R, Correr CJ, Pontarolo R. Cost-effectiveness of telbivudine versus lamivudine for chronic hepatitis B. Braz J Infect Dis. 2011; 15(3): 225-30[PubMed]
  • 17. Poorolajal J, Majdzadeh R. Prevalence of chronic hepatitis B infection in Iran: a review article. J Res Med Sci. 2009; 14(4): 249-58[PubMed]
  • 18. Salem F, Hekmat S, Aghasadeghi MR, Javadi F, Gholami H, Mostafavi E. Prevalence and Risk Factors of Hepatitis B Virus Genotype D Amongst Inmates in Alborz Province, Iran: A Cross-Sectional Survey. Jundishapur J Microbiol. 2013; 6(6)[DOI]
  • 19. Abdoli G. Estimating the social discount rate for Iran [in Persian]. J Econ Res. 2009; 3: 135-56
  • 20. Robberstad B. Estimation of private and social time preferences for health in northern Tanzania. Soc Sci Med. 2005; 61(7): 1597-607[DOI][PubMed]
  • 21. Nikfar S, Kebriaeezadeh A, Dinarvand R, Abdollahi M, Sahraian MA, Henry D, et al. Cost-effectiveness of different interferon beta products for relapsing-remitting and secondary progressive multiple sclerosis: Decision analysis based on long-term clinical data and switchable treatments. Daru. 2013; 21(1): 50[DOI][PubMed]
  • 22. Mohammadnezhad M, Malekzadeh Z. Guidelines On The Management Of Chronic Hepatitis B [in Persian]. Govaresh J. 19(2): 128-40
  • 23. Bobes J, Canas F, Rejas J, Mackell J. Economic consequences of the adverse reactions related with antipsychotics: an economic model comparing tolerability of ziprasidone, olanzapine, risperidone, and haloperidol in Spain. Prog Neuropsychopharmacol Biol Psychiatry. 2004; 28(8): 1287-97[DOI][PubMed]
  • 24. Bell C, Graham J, Earnshaw S, Oleen-Burkey M, Castelli-Haley J, Johnson K. Cost-effectiveness of four immunomodulatory therapies for relapsing-remitting multiple sclerosis: a Markov model based on long-term clinical data. J Manag Care Pharm. 2007; 13(3): 245-61[DOI][PubMed]
  • 25. Nuijten MJ, Hutton J. Cost-effectiveness analysis of interferon beta in multiple sclerosis: a Markov process analysis. Value Health. 2002; 5(1): 44-54[DOI][PubMed]
  • 26. Nikfar S. A new model for decision analysis in economic evaluations of switchable health interventions. J Med Hypotheses Ideas. 2012; 6(1): 12-5[DOI]
  • 27. Lok AS, Zoulim F, Locarnini S, Bartholomeusz A, Ghany MG, Pawlotsky JM, et al. Antiviral drug-resistant HBV: standardization of nomenclature and assays and recommendations for management. Hepatology. 2007; 46(1): 254-65[DOI][PubMed]
  • 28. Zoulim F, Locarnini S. Hepatitis B virus resistance to nucleos(t)ide analogues. Gastroenterology. 2009; 137(5): 1593-608[DOI][PubMed]
  • 29. Pawlotsky JM, Dusheiko G, Hatzakis A, Lau D, Lau G, Liang TJ, et al. Virologic monitoring of hepatitis B virus therapy in clinical trials and practice: recommendations for a standardized approach. Gastroenterology. 2008; 134(2): 405-15[DOI][PubMed]
  • 30. EASL clinical practice guidelines: Management of chronic hepatitis B virus infection. J Hepatol. 2012; 57(1): 167-85[DOI][PubMed]
  • 31. Gish R, Jia JD, Locarnini S, Zoulim F. Selection of chronic hepatitis B therapy with high barrier to resistance. Lancet Infect Dis. 2012; 12(4): 341-53[DOI][PubMed]
  • 32. Berg T, Möller B, Gerken G, Jung MC, Spengler U, Hartmann H, et al. Tenofovir disoproxil fumarate (TDF) versus Emtricitabine plus TDF for treatment of chronic Hepatitis B (CHB) in subjects with persistent viral replication receiving Adefovir dipivoxil (ADV). Zeitschrift Gastroenterol. 2008; 46(9)[DOI]
  • 33. Sung JJY, Lai JY, Zeuzem S, Chow WC, Heathcote E, Perrillo R, et al. A randomised double-blind phase II study of lamivudine (LAM) compared to lamivudine plus adefovir dipovoxil (ADV) for treatment naïve patients with chronic hepatitis B (CHB): Week 52 analysis. J Hepatol. 2003; 38: 25-6[DOI]
  • 34. Lai CL, Leung N, Teo EK, Tong M, Wong F, Hann HW, et al. A 1-year trial of telbivudine, lamivudine, and the combination in patients with hepatitis B e antigen-positive chronic hepatitis B. Gastroenterology. 2005; 129(2): 528-36[DOI][PubMed]
  • 35. Woo G, Tomlinson G, Nishikawa Y, Kowgier M, Sherman M, Wong DK, et al. Tenofovir and entecavir are the most effective antiviral agents for chronic hepatitis B: a systematic review and Bayesian meta-analyses. Gastroenterology. 2010; 139(4): 1218-29[DOI][PubMed]
  • 36. Dakin H, Fidler C, Harper C. Mixed treatment comparison meta-analysis evaluating the relative efficacy of nucleos(t)ides for treatment of nucleos(t)ide-naive patients with chronic hepatitis B. Value Health. 2010; 13(8): 934-45[DOI][PubMed]
  • 37. Marcellin P, Heathcote EJ, Buti M, Gane E, de Man RA, Krastev Z, et al. Tenofovir disoproxil fumarate versus adefovir dipivoxil for chronic hepatitis B. N Engl J Med. 2008; 359(23): 2442-55[DOI][PubMed]
  • 38. Iloeje UH, Yang HI, Su J, Jen CL, You SL, Chen CJ, et al. Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology. 2006; 130(3): 678-86[DOI][PubMed]
  • 39. Chang TT, Gish RG, de Man R, Gadano A, Sollano J, Chao YC, et al. A comparison of entecavir and lamivudine for HBeAg-positive chronic hepatitis B. N Engl J Med. 2006; 354(10): 1001-10[DOI][PubMed]
  • 40. Eun JR, Lee HJ, Kim TN, Lee KS. Risk assessment for the development of hepatocellular carcinoma: according to on-treatment viral response during long-term lamivudine therapy in hepatitis B virus-related liver disease. J Hepatol. 2010; 53(1): 118-25[DOI][PubMed]
  • 41. Yang HI, Yuen MF, Chan HL, Han KH, Chen PJ, Kim DY, et al. Risk estimation for hepatocellular carcinoma in chronic hepatitis B (REACH-B): development and validation of a predictive score. Lancet Oncol. 2011; 12(6): 568-74[DOI][PubMed]
  • 42. Toy M, Onder FO, Idilman R, Kabacam G, Richardus JH, Bozdayi M, et al. The cost-effectiveness of treating chronic hepatitis B patients in a median endemic and middle income country. Eur J Health Econ. 2012; 13(5): 663-76[DOI][PubMed]
  • 43. Yurdaydin C, Bozkaya H, Cetinkaya H, Sahin T, Karaoguz D, Toruner M, et al. Lamivudine vs lamivudine and interferon combination treatment of HBeAg(-) chronic hepatitis B. J Viral Hepat. 2005; 12(3): 262-8[DOI][PubMed]
  • 44. Chan HL, Heathcote EJ, Marcellin P, Lai CL, Cho M, Moon YM, et al. Treatment of hepatitis B e antigen positive chronic hepatitis with telbivudine or adefovir: a randomized trial. Ann Intern Med. 2007; 147(11): 745-54[PubMed]
  • 45. Levy AR, Kowdley KV, Iloeje U, Tafesse E, Mukherjee J, Gish R, et al. The impact of chronic hepatitis B on quality of life: a multinational study of utilities from infected and uninfected persons. Value Health. 2008; 11(3): 527-38[DOI][PubMed]
  • 46. Chen CJ, Yang HI, Iloeje UH, Reveal-Hbv Study Group . Hepatitis B virus DNA levels and outcomes in chronic hepatitis B. Hepatology. 2009; 49(5 Suppl): 72-84[DOI][PubMed]
  • 47. Kanwal F, Gralnek IM, Martin P, Dulai GS, Farid M, Spiegel BM. Treatment alternatives for chronic hepatitis B virus infection: a cost-effectiveness analysis. Ann Intern Med. 2005; 142(10): 821-31[PubMed]
  • 48. Lynch SV, Balderson GA. ANZLT Registry Report 2007 2007;
  • 49. Sali S, Alavian SM, Foster GR, Keyvani H, Mehrnoosh L, Mohammadi N. Influencing Factors on the Outcome and Prognosis of Patients With HBV Infction: Seven Years Follow-up. Hepat Mon. 2013; 13(7): 8743[DOI][PubMed]
  • 50. Life tables by country Iran (Islamic Republic of).
  • 51. Duberg AS, Torner A, Davidsdottir L, Aleman S, Blaxhult A, Svensson A, et al. Cause of death in individuals with chronic HBV and/or HCV infection, a nationwide community-based register study. J Viral Hepat. 2008; 15(7): 538-50[DOI][PubMed]
  • 52. Sun X, Faunce T. Decision-analytical modelling in health-care economic evaluations. Eur J Health Econ. 2008; 9(4): 313-23[DOI][PubMed]
  • 53. Goudarzi R. Estimating quality weights for EQ-5D health states with the time trade-off (TTO) method in Iran [Dissertation]. 2014;
  • 54. The Rate Currency.
  • 55. PPP conversion factor, private consumption (LCU per international $).
  • 56. Buti M, Brosa M, Casado MA, Rueda M, Esteban R. Modeling the cost-effectiveness of different oral antiviral therapies in patients with chronic hepatitis B. J Hepatol. 2009; 51(4): 640-6[DOI][PubMed]
  • 57. Shillcutt SD, Walker DG, Goodman CA, Mills AJ. Cost effectiveness in low- and middle-income countries: a review of the debates surrounding decision rules. Pharmacoeconomics. 2009; 27(11): 903-17[DOI][PubMed]
  • 58. Tantai N, Chaikledkaew U, Tanwandee T, Werayingyong P, Teerawattananon Y. A cost-utility analysis of drug treatments in patients with HBeAg-positive chronic hepatitis B in Thailand. BMC Health Serv Res. 2014; 14: 170[DOI][PubMed]
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