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Cost-effectiveness of antiviral therapy in untreated compensated cirrhosis patient with serum HBV-DNA level < 2000 IU/mL

 Hankil Lee  ;  Sungin Jang  ;  Sang Hoon Ahn  ;  Beom Kyung Kim 
 HEPATOLOGY INTERNATIONAL, Vol.16(2) : 294-305, 2022-04 
Journal Title
Issue Date
Antiviral Agents ; Carcinoma, Hepatocellular* / pathology ; Cost-Benefit Analysis ; DNA, Viral ; Hepatitis B virus / genetics ; Hepatitis B, Chronic* / complications ; Hepatitis B, Chronic* / drug therapy ; Hepatitis B, Chronic* / pathology ; Humans ; Liver Cirrhosis / pathology ; Liver Neoplasms* / pathology ; Middle Aged
Antiviral therapy ; Compensated cirrhosis ; Cost-effectiveness analysis ; Hepatitis B virus ; Low-level viremia
Background: Due to stringent reimbursement criteria, significant numbers of patients with compensated cirrhosis (CC) and low-level viremia [LLV; serum hepatitis B virus (HBV)-DNA levels of 20-2000 IU/mL] remain untreated especially in the East Asian countries, despite potential risk of disease progression. We analyzed cost-effectiveness to assess rationales for antiviral therapy (AVT) for this population.

Methods: We compared cost and effectiveness (quality-adjusted life years, QALYs) in a virtual cohort including 10,000 54-year-old CC-LLV patients receiving AVT (Scenario I) versus no treatment (Scenario II). A Markov model, including seven HBV-related conditions, was used. Values for transition probabilities and costs were mostly obtained from recent real-world South Korean data.

Results: As per a simulation of a base-case analysis, AVT reduced costs by $639 USD and yielded 0.108 QALYs per patient for 5 years among CC-LLV patients compared to no treatment. Thus, AVT is a cost-saving option with lower costs and better effectiveness than no treatment. If 10,000 patients received AVT, 815 incident cases of hepatocellular carcinoma (HCC) and 630 HBV-related deaths could be averted in 5 years compared to no treatment. In case of 10-year observation, AVT was consistently dominant. Even when the transition probabilities from CC-LLV vs. maintained virological response to HCC were same, fluctuation of results also lied within willingness-to-pay in South Korea. In the probabilistic sensitivity analysis with the willingness-to-pay threshold, the probability of AVT cost-effectiveness was 100%.

Conclusion: The extended application of AVT in CC-LLV patients may contribute positively to individual clinical benefits and national healthcare budgets.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Jang, Sung In(장성인) ORCID logo https://orcid.org/0000-0002-0760-2878
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