OBJECTIVES : This study aimed to assess the disease progression and cost-effectiveness of lamivudinein (LMV), telbivudine (LdT), and entecavir (ETV), adefovir dipivoxil (ADV)+ETV, LMV+ADV versus ADV therapy in chronic hepatitis B (CHB) patients in eight-year retrospective cohort study.

METHODS : This retrospective cohort study included 1434 CHB patients who received monotherapy or combined antiviral therapy at the Eighth People's Hospital of Guangzhou from January 1, 2008 to December 31, 2012, and were followed up until December 31, 2016. The net monetary benefit (NMB) was used to analyze the disease progression (progression to cirrhosis/hepatocellular carcinoma) and cost-effectiveness of different antiviral treatments and the willingness to pay (WTP) was taken to be ¥155,594 per life-year (3x per capita gross domestic product in 2016). The simple weighted method was used to estimate treatment effects and medical costs under informative censoring. Inverse probability weighting estimation based on propensity scores was used to adjust for potential confounding in observational data. Costs were discounted at 5% per annum.

RESULTS : A total of 1434 CHB patients treated by ADV (n=250), LMV (n=80), LdT (n=178), ETV (n=625), ADV+ETV (n=139), LMV+ADV (n=162), respectively. Over an eight-year time horizon, estimated disease-free survival (years) of LMV, ETV, LdT, ADV+ETV, and LMV+ADV were longer than ADV (6.67, 7.18, 6.80, 7.56, and 7.68 versus 6.63, respectively). Estimated total health care costs of ADV+ETV and LMV+ADV were higher than ADV (¥41,169.68 and ¥42,469.41 versus ¥38,400.29, respectively). Estimated total health care costs of LMV, ETV, and LdT were lower than ADV (¥28,867.04, ¥35,695.25, ¥23,662.67 versus ¥38,400.29, respectively). For net monetary benefit gained, LMV+ADV (NMB: ¥159,304.58) was the optimal selection.

CONCLUSIONS : This analysis suggests that ETV, ADV+ETV, and LMV+ADV improve survival outcomes compared with ADV in CHB patients. Furthermore, when the WTP is ¥155,594 per life-year, LMV+ADV were the most cost-effective treatment option.