OBJECTIVES: hepatitis B infection is the major cause of chronic liver disease in Iran. The aim of this study is to assess the cost utility of entecavir versus tenofovir in patients with CHB infection in Iran.

METHODS: A markov decision analytic model was developed to simulate CHB transitioning through different states over a course of patient’s life time. The model uses one-year cycles. The analysis was undertaken from the third party payer perspective.

The transition probabilities were derived from literature. Medical direct costs were considered and extracted from "relative value of health utility Of Iran" book.

Outcomes were measured as Qaly (quality-adjusted life-years). Utility scores were obtained using EQ-5D questionnaires from 155 cases. Discount rate 5% and threshold considered 1 GDP (The Gross Domestic Product )/capita. The GDP/capita in Iran was 113,000,000 Rials. The exchange rate was 32,844 Rials per USD.

RESULTS: Results showed lower cost of entecavir in every states and lower efficacy in comparison to tenofovir.

Qaly was 13.32 and 13.64 and total costs were 203,246,610 and 246,310,905 Rials for entecavir and tenofovir respectively. The incremental cost per QALY for tenofovir vs entecavir was 132,132,284 Rials. Sensitivity analysis by Monte Carlo shows relatively accurate results.

CONCLUSIONS: In comparison between entecavir and tenofovir, considering the threshold in Iran, entecavir would be the preferred choice. Although better efficacy of tenofovir, its incremental cost per QALY is higher than acceptable threshold which means the comparator would be preferred choice. As the cost per QALY ratio is close to threshold, tenofovir could be accepted for financing medicines in Iran too.