KMID : 1103920090150010025
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Korean Journal of Hepatology 2009 Volume.15 No. 1 p.25 ~ p.41
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Analysis of the cost-effectiveness of antiviral therapies in chronic hepatitis B patients in Korea
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Kim Byung-Kook
Kwon So-Young Lee Chang-Hong Choe Won-Hyeok Choi Hong-Mi Koo Hye-Won
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Abstract
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Backgrounds/Aims:The purpose of this study was to evaluate the cost-effectiveness of 1 year and up to 5 years of antiviral treatment for chronic hepatitis B (CHB).
Methods:Two ten-health-state Markov models were developed for CHB patients. The proportion of patients remaining alive in each health state, and healthcare costs and quality-adjusted life years (QALYs) were determined during annual cycles of these Markov models. The total healthcare costs, life years, and QALYs over the 40-year time horizon of the model were calculated. The perspectives of the cost-effectiveness analysis were the Korean healthcare system and the healthcare needs of the CHB patient.
Results:Short-course therapy with ¥á-interferon or 1-year treatment with pegylated interferon ¥á-2a, lamivudine (LMV), or adefovir (ADV) had limited impact on disease progression. In contrast, either LMV-ADV or ADV-LMV as rescue medication administered for 5 years resulted in a more sustained decrease in the rate of disease progression. The cost-effectiveness threshold in Korea was estimated to be approximately 25,000,000 South Korean won. LMV administered for 1 year is cost-effective in comparison with no treatment for both HBeAg-positive and HBeAg-negative CHB patients, but longer duration antiviral therapies administered for up to 5 years in CHB patients were found to be highly cost-effective by international standards.
Conslusions:Antiviral treatment of CHB with LMV or ADV for up to 5 years using the alternative antiviral agent as rescue medication appears to be a cost-effective strategy for both HBeAg-positive and HBeAg-negative CHB patients in Korea. Economic evaluation of antiviral therapies should be studied further and updated, particularly for newer agents.
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KEYWORD
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Chronic hepatitis B, Antiviral agents, Treatment outcome, Cost effectiveness
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