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PEG-IFN proved cost-effective in patients with HBV, HBeAg

The 12-week stopping rule for pegylated interferon implemented by Hong Kong was the most cost-effective treatment for patients with chronic hepatitis B virus who were positive for hepatitis B e antigen, according to data from a recent study.

Researchers used Markov modeling and data from PubMed of chronic hepatitis B virus (HBV) patients, aged 35-years, who were positive for hepatitis B e antigen (HBeAg) and patients, aged 40 years, who were negative for HBeAg to determine the cost-effectiveness of stopping 12-week treatment with pegylated interferon (PEG-IFN). The researchers compared the following treatments: PEG-IFN with 12-week stopping rule; PEG-IFN with conventional 48-week treatment; entecavir monotherapy; tenofovir monotherapy; telbivudine monotherapy; telbivudine roadmap with tenofovir switch therapy; and no treatment.

Stopping treatment after 12 weeks was the best option for HBeAg-positive patients because it had the lowest cost-effectiveness ratio (CER) of $9,501 per quality-adjusted life-year (QALY), compared with no treatment or treatment for 48 weeks (CER, $9,664 per QALY). Entecavir was the lowest CER (lifetime cost, $70,028) compared with no treatment, if PEG-IFN was not an option.

Long-term antiviral treatment is needed for patients negative for HBeAg; therefore, entecavir treatment was the most cost-effective, with the lowest CER ($34,310 per QALY) compared with PEG-IFN for 12 weeks ($37,423 per QALY) or 48 weeks ($38,474 per QALY).

“If [PEG-IFN] can be made affordable, the 12-week stopping rule significantly increases the cost-effectiveness of [PEG-IFN] strategy, making it the most cost-effective strategy for HBeAg positive patients in Hong Kong,” the researchers wrote. “It reduces unnecessary treatment futility and may allow more people to avoid long-term oral antiviral treatment and achieve long-term [hepatitis B surface antigen] seroclearance.

“For HBeAg negative patients, the need of long-term antivirals makes entecavir the most cost-effective strategy, especially when the drug becomes cheaper with availability of generic versions.”

Disclosure: See the study for a full list of relevant financial disclosures.