COST-EFFECTIVENESS OF FOUR FIRST-LINE ANTI-VIRAL TREATMENTS FOR HBEAG-POSITIVE AND HBEAG-NEGATIVE CHRONIC HEPATITIS B PATIENTS IN CHINA
Author(s)
Mengdie Zhang, Bachelor of Science1, Zhu Haomin, Bachelor of Science2, yaling yang, PhD3, Junwen Zhou, PhD4, Gao Lihong, Bachelor of Science2, Wang Jia, Bachelor of Science2, Xin Li, PhD5.
1Nanjing Medical University, Nanjing, China, 2Nanjing Medical University, jiangsu, China, 3Oxford University, Oxford, United Kingdom, 4University of Oxford, Oxford, United Kingdom, 5Professor, the Director of department of Clinical Pharmacy, Nanjing Medical University, Nanjing, China.
1Nanjing Medical University, Nanjing, China, 2Nanjing Medical University, jiangsu, China, 3Oxford University, Oxford, United Kingdom, 4University of Oxford, Oxford, United Kingdom, 5Professor, the Director of department of Clinical Pharmacy, Nanjing Medical University, Nanjing, China.
OBJECTIVES: China bears the highest disease burden of chronic hepatitis B (CHB) globally. Current guidelines recommend entecavir (ETV), tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF), and tenofovir amibufenamide (TMF) as first-line therapies. This study evaluated their cost-effectiveness from a Chinese healthcare system perspective.
METHODS: Markov models were constructed separately for HBeAg-positive and HBeAg-negative CHB patients, and two treatment endpoints were assessed per pipulation: the satisfactory endpoint (sustained virologic response, with HBeAg seroconversion in HBeAg-positive patients) and the ideal endpoint (HBsAg clearance). Outcomes included lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefit. Robustness of model results were assessed via one-way sensitivity analyses and probabilistic sensitivity analyses (PSA). In the scenario analysis, we also incorporated a societal-perspective and alternative drug-pricing assumptions arising from different pharmaceutical policies.
RESULTS: For HBeAg-positive patients, ETV and TAF were the most effective and cost-effective strategies at the satisfactory (14.06 QALYs; ICER $9,683) and ideal (14.71 QALYs; ICER $10,816) endpoint, respectively. For HBeAg-negative patients, TDF dominated at the satisfactory endpoint (13.20 QALYs; ICER $1,105), and TMF dominated at the ideal endpoint (16.39 QALYs; ICER $4,642). Cost-effectiveness conclusions for HBeAg-negative patients under the satisfactory endpoint weren’t robust in one-way sensitivity analysis, the rate of spontaneous HBsAg clearance following virological relapse was the most influential parameter. PSA showed TDF had a 100% probability of cost-effectiveness for HBeAg-positive patients at the ideal endpoint, while TMF was preferred for HBeAg-negative patients (regardless of endpoints). The societal perspective revealed similar results. Both the National Drug Price Negotiation policy and the market launch of generic medicines have significantly improved the cost-effectiveness of antiviral therapies.
CONCLUSIONS: All four regimens demonstrated context-specific cost-effectiveness advantages, with TMF demonstrating a notable efficacy-economic synergy in HBeAg-negative patients. The ideal endpoint was recommended given its superior health benefits and stable cost-effectiveness. We also appeal for improved access to generics.
METHODS: Markov models were constructed separately for HBeAg-positive and HBeAg-negative CHB patients, and two treatment endpoints were assessed per pipulation: the satisfactory endpoint (sustained virologic response, with HBeAg seroconversion in HBeAg-positive patients) and the ideal endpoint (HBsAg clearance). Outcomes included lifetime costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and net monetary benefit. Robustness of model results were assessed via one-way sensitivity analyses and probabilistic sensitivity analyses (PSA). In the scenario analysis, we also incorporated a societal-perspective and alternative drug-pricing assumptions arising from different pharmaceutical policies.
RESULTS: For HBeAg-positive patients, ETV and TAF were the most effective and cost-effective strategies at the satisfactory (14.06 QALYs; ICER $9,683) and ideal (14.71 QALYs; ICER $10,816) endpoint, respectively. For HBeAg-negative patients, TDF dominated at the satisfactory endpoint (13.20 QALYs; ICER $1,105), and TMF dominated at the ideal endpoint (16.39 QALYs; ICER $4,642). Cost-effectiveness conclusions for HBeAg-negative patients under the satisfactory endpoint weren’t robust in one-way sensitivity analysis, the rate of spontaneous HBsAg clearance following virological relapse was the most influential parameter. PSA showed TDF had a 100% probability of cost-effectiveness for HBeAg-positive patients at the ideal endpoint, while TMF was preferred for HBeAg-negative patients (regardless of endpoints). The societal perspective revealed similar results. Both the National Drug Price Negotiation policy and the market launch of generic medicines have significantly improved the cost-effectiveness of antiviral therapies.
CONCLUSIONS: All four regimens demonstrated context-specific cost-effectiveness advantages, with TMF demonstrating a notable efficacy-economic synergy in HBeAg-negative patients. The ideal endpoint was recommended given its superior health benefits and stable cost-effectiveness. We also appeal for improved access to generics.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE649
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Health Technology Assessment
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Infectious Disease (non-vaccine)