Cost-Effectiveness of Switching from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide Vs. Entecavir for Chronic Hepatitis B Patients in Greece
Author(s)
Sinakos E1, Kachru N2, Tsoulas C3, Jeyakumar S4, Smith N5, Yehoshua A2, Cholongitas E6
1Aristotle University of Thessaloniki, Thessaloniki, Greece, 2Gilead Sciences Inc., Foster City, CA, USA, 3Gilead Sciences Hellas, Athens, A1, Greece, 4Maple Health Group, LLC, Jersey City, NJ, USA, 5Maple Health Group, LLC, New York, NY, USA, 6Medical School of National and Kapodistrian University of Athens, Athens, Greece
Presentation Documents
OBJECTIVES: This study aimed to assess the cost-effectiveness of switching from TDF to TAF (TDF→TAF) versus switching to ETV (TDF→ETV) in the treatment of Greek CHB patients > 60 years.
METHODS: A patient-level simulation model was developed to compare costs and clinical outcomes over a 50-year time horizon from a Greek national payer perspective. The population was 60-year-old adults either treatment-experienced (TE) or mixed population of treatment-naïve and -experience (TN/E) CHB. Clinical outcomes included numbers of advanced liver complications, chronic kidney disease (CKD) and major osteoporotic facture (MOF) events; other outcomes included life years (LYs), quality-adjusted-life years (QALYs), and incremental cost-effectiveness ratios (ICERs). Risk of hepatocellular carcinoma (HCC) was estimated in two approaches, treatment-based (TBA) or time to ALT normalization (ANA). All inputs were drawn from clinical trials or published literature. Costs and outcomes were discounted at annual rate of 3.5%.
RESULTS: TDF→TAF resulted in improved health outcomes vs. TDF→ETV. In TN/E patients, the incidence rates of HCC (TBA: 7.07% vs. 7.43%, ANA: 11.26% vs. 11.39%), and of liver transplantation were lower (TBA: 0.16% vs. 0.17%, ANA: 0.20% vs. 0.21%) in TDF→TAF vs. TDF→ETV. Same pattern was observed in TE only patients. A lower number of CKD events was observed in TDF→TAF across populations while MOF events remained similar across treatment groups and populations. TDF→TAF vs. TDF→ETV resulted in LY and QALY improvements. The intervention was costlier across all scenarios (range, €356 - €521). In the TN/E population, TDF→TAF vs. TDF→ETV resulted in ICERs of €17,324/QALY and €23,267/QALY for TBA and ANA, respectively. In TE patients, the ICERs were €17,113/QALY and €22,710/QALY for TBA and ANA scenarios, respectively. Results were robust in one-way sensitivity analyses.
CONCLUSIONS: TDF→TAF is cost-effective vs. TDF→ETV across treatment-naïve and -experienced patients when considering a willingness-to-pay threshold of €36,000/QALY (1x Greek GDP).
Conference/Value in Health Info
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
EE128
Topic
Clinical Outcomes, Economic Evaluation
Topic Subcategory
Comparative Effectiveness or Efficacy, Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Drugs