Cost-effectiveness of Interferon-2b Treatment for Hepatitis B e Antigen-Positive Chronic Hepatitis B

1 May 1995 | Volume 122 Issue 9 | Pages 664-675

Objective: To estimate the cost-effectiveness of interferon-2B for the treatment of patients with chronic hepatitis B infection who are positive for hepatitis B e antigen (HBeAg).

Design: Meta-analysis of nine randomized controlled trials and cost-effectiveness analysis, projecting the clinical and economic outcomes expected from changes in serologic markers of hepatitis B viral replication.

Data Sources: MEDLINE search, expert panel opinion, hospital cost data, and adjusted physician charges.

Patients: 552 patients with confirmed chronic hepatitis B infection who were positive for HBeAg.

Intervention: Interferon-2b.

Measurements: Lifetime incidence of cirrhosis and hepatocellular carcinoma; life expectancy; quality-adjusted life expectancy; and costs and marginal cost-effectiveness ratios from a societal perspective.

Results: Interferon-2b increases the likelihood of becoming negative for HBeAg from 9.1% to 45.6% (difference, 36.5%; 95% CI, 23.7% to 49.2%) and of becoming negative for hepatitis B surface antigen from 1.7% to 7.7% (difference, 6.0%; CI, 2.8% to 9.3%) in the first year. For a 35-year-old person with chronic hepatitis B who is HBeAg positive, our analysis suggests that interferon-2b will increase life expectancy by 3.1 years or 3.4 quality-adjusted life-years and will decrease projected lifetime costs, even if future savings are discounted; thus, interferon-2b is the dominant strategy. Even with the model biased strongly in favor of standard care, the marginal cost-effectiveness ratio of interferon did not exceed $12 000 per life-year gained.

Conclusions: Interferon-2b should prolong life and lower costs for patients with chronic hepatitis B who are HBeAg positive.

Author and Article Information

From New England Medical Center and Tufts University School of Medicine, Boston, Massachusetts. MetroWest Medical Center, Framingham, Massachusetts. V. Cervello Hospital, Palermo, Italy.
Requests for Reprints: Stephen G. Pauker, MD, New England Medical Center, 750 Washington Street, Box 302, Boston, MA 02111.
Disclaimer: Schering-Plough, the manufacturer of interferon-2b, provided funding for this study but had no input regarding its content. The investigators retained full independence to publish the study results, regardless of the outcome of the analysis.
Acknowledgments: The authors thank the advisory panel of experts for guidance and information. Panel members included Robert Carithers, MD (University of Washington); Marshall Kaplan, MD (New England Medical Center); Emmet B. Keeffe, MD (Stanford University); Robert P. Perrillo, MD (Ochsner Clinic); Fredric Regenstein, MD (Ochsner Clinic); Eugene Schiff, MD (University of Miami); and Leonard B. Seeff, MD (Veterans Affairs Medical Center, Washington, D.C.).
Grant Support: In part by grant LM04493 from the National Library of Medicine, Bethesda, Maryland and a grant from Schering-Plough Laboratories. This research was done, in part, while Dr. Tine was a visiting physician at New England Medical Center and Tufts University School of Medicine.