Cost-effectiveness of Interferon-α2b Treatment for Hepatitis B e Antigen-Positive Chronic Hepatitis B

doi:10.1059/0003-4819-122-9-199505010-00004

Cost-effectiveness of Interferon-α2b Treatment for Hepatitis B e Antigen-Positive Chronic Hepatitis B

From New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts. MetroWest Medical Center, Framingham, Massachusetts. V. Cervello Hospital, Palermo, Italy. Requests for Reprints: Stephen G. Pauker, MD, New England Medical Center, 750 Washington Street, Box 302, Boston, MA 02111. Disclaimer: Schering-Plough, the manufacturer of interferon-α2b, provided funding for this study but had no input regarding its content. The investigators retained full independence to publish the study results, regardless of the outcome of the analysis. Acknowledgments: The authors thank the advisory panel of experts for guidance and information. Panel members included Robert Carithers, MD (University of Washington); Marshall Kaplan, MD (New England Medical Center); Emmet B. Keeffe, MD (Stanford University); Robert P. Perrillo, MD (Ochsner Clinic); Fredric Regenstein, MD (Ochsner Clinic); Eugene Schiff, MD (University of Miami); and Leonard B. Seeff, MD (Veterans Affairs Medical Center, Washington, D.C.). Grant Support: In part by grant LM04493 from the National Library of Medicine, Bethesda, Maryland and a grant from Schering-Plough Laboratories. This research was done, in part, while Dr. Tine was a visiting physician at New England Medical Center and Tufts University School of Medicine.

Abstract

Objective: To estimate the cost-effectiveness of interferon-α2B for the treatment of patients with chronic hepatitis B infection who are positive for hepatitis B e antigen (HBeAg).

Design: Meta-analysis of nine randomized, controlled trials and cost-effectiveness analysis, projecting the clinical and economic outcomes expected from changes in serologic markers of hepatitis B viral replication.

Data Sources: MEDLINE search, expert panel opinion, hospital cost data, and adjusted physician charges.

Patients: 552 patients with confirmed chronic hepatitis B infection who were positive for HBeAg.

Intervention: Interferon-α2b.

Measurements: Lifetime incidence of cirrhosis and hepatocellular carcinoma; life expectancy; quality-adjusted life expectancy; and costs and marginal cost-effectiveness ratios from a societal perspective.

Results: Interferon-α2b increases the likelihood of becoming negative for HBeAg from 9.1% to 45.6% (difference, 36.5%; 95% CI, 23.7% to 49.2%) and of becoming negative for hepatitis B surface antigen from 1.7% to 7.7% (difference, 6.0%; CI, 2.8% to 9.3%) in the first year. For a 35-year-old person with chronic hepatitis B who is HBeAg positive, our analysis suggests that interferon-α2b will increase life expectancy by 3.1 years or 3.4 quality-adjusted life-years and will decrease projected lifetime costs, even if future savings are discounted; thus, interferon-α2b is the dominant strategy. Even with the model biased strongly in favor of standard care, the marginal cost-effectiveness ratio of interferon did not exceed $12 000 per life-year gained.

Conclusions: Interferon-α2b should prolong life and lower costs for patients with chronic hepatitis B who are HBeAg positive.