Publication: A cost-utility analysis of drug treatments in patients with HBeAg-positive chronic hepatitis B in Thailand
Issued Date
2014
Resource Type
Language
eng
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Mahidol University
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BioMed Central
Bibliographic Citation
BMC Health Services Research. Vol. 14, (2014),170
Suggested Citation
Narisa Tantai, Usa Chaikledkaew, Tawesak Tanwandee, Pitsaphun Werayingyong, Yot Teerawattananon A cost-utility analysis of drug treatments in patients with HBeAg-positive chronic hepatitis B in Thailand. BMC Health Services Research. Vol. 14, (2014),170. doi:10.1186/1472-6963-14-170. Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/2776
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Thesis
Title
A cost-utility analysis of drug treatments in patients with HBeAg-positive chronic hepatitis B in Thailand
Abstract
Background: Only lamivudine has been included for patients with chronic hepatitis B (CHB) in the National List of
Essential Drugs (NLED), a pharmaceutical reimbursement list in Thailand. There have also been no economic
evaluation studies of CHB drug treatments conducted in Thailand yet. In order to fill this gap in policy research, the
objective of this study was to compare the cost-utility of each drug therapy (Figure 1) with palliative care in patients
with HBeAg-positive CHB.
Methods: A cost-utility analysis using an economic evaluation model was performed to compare each drug treatment
for HBeAg-positive CHB patients. A Markov model was used to estimate the relevant costs and health outcomes during a
lifetime horizon based on a societal perspective. Direct medical costs, direct non-medical costs, and indirect costs were
included, and health outcomes were denoted in life years (LYs) and quality-adjusted life years (QALYs). The results were
presented as an incremental cost effectiveness ratio (ICER) in Thai baht (THB) per LY or QALY gained. One-way sensitivity
and probabilistic sensitivity analyses were applied to investigate the effects of model parameter uncertainties.
Results: The ICER values of providing generic lamivudine with the addition of tenofovir when drug resistance occurred,
generic lamivudine with the addition of tenofovir based on the road map guideline, and tenofovir monotherapy
were -14,000 (USD -467), -8,000 (USD -267) , and -5,000 (USD -167) THB per QALY gained, respectively. However, when
taking into account all parameter uncertainties in the model, providing generic lamivudine with the addition of tenofovir
when drug resistance occurred (78% and 75%) and tenofovir monotherapy (18% and 24%) would yield higher
probabilities of being cost-effective at the societal willingness to pay thresholds of 100,000 (USD 3,333) and 300,000
(USD 10,000) THB per QALY gained in Thailand, respectively.
Conclusions: Based on the policy recommendations from this study, the Thai government decided to include tenofovir
into the NLED in addition to generic lamivudine which is already on the list. Moreover, the results have shown that the
preferred treatment regimen involves using generic lamivudine as the first-line drug with tenofovir added if drug
resistance occurs in HBeAg-positive CHB patients.