Presentation (CTI)

OBJECTIVES: Chronic hepatitis B (CHB) affects a large number of people in India, with an estimated 3-4% prevalence, and many patients require long-term treatment to prevent serious liver complications. In a setting where healthcare resources are limited, treatment choices need to make both clinical and economic sense. This study compared the cost-utility of Tenofovir Disoproxil Fumarate (TDF) and Entecavir (ETV) for CHB from a healthcare payer perspective.
METHODS: We used a Markov state-transition model to describe how patients move through different stages of disease while receiving antiviral therapy. The model included eight health states, with death as the absorbing state. Estimates for disease progression, costs, and health-related quality of life were taken from published literature. Outcomes were measured as quality-adjusted life years (QALYs), and costs were calculated in Indian Rupees (₹). To account for uncertainty in the model inputs, we conducted a probabilistic sensitivity analysis (PSA). Results were evaluated using a willingness-to-pay threshold of ₹1,50,000 per QALY.
RESULTS: Treatment with TDF resulted in lower overall costs (₹26,81,200) compared with ETV (₹27,44,200), while also having better health outcomes. Patients receiving TDF accrued 14.81467 QALYs, whereas those receiving ETV accrued 14.31008 QALYs. TDF saved costs and improved outcomes, producing a negative ICER of −₹1,24,851.11 per QALY. The PSA supported these findings.
CONCLUSIONS: From the perspective of the Indian healthcare payer, TDF provides more health benefit at a lower cost than ETV for chronic hepatitis B, making it a strong value-for-money option for routine clinical use. This evidence can inform treatment guidelines, public-sector procurement, and reimbursement decisions, ensure efficient use of healthcare resources while improving patient outcomes.