Tenofovir disoproxil fumarate is superior to Entecavir and Tenofovir alafenamide in Cost-Effectiveness of Treatment of Chronic Hepatitis B in China with New Volume-Based Purchasing Policy

Abstract

Abstract Background/Aim: Evidence indicates long-term nucleos(t)ide analogs (NAs) therapy can improve the prognosis of chronic hepatitis B (CHB). However, the optimized choice of first-line NAs in cost-effectiveness was still obscure. In 2019, China’s New Volume-Based Purchasing Policy (NVBPP) was implemented with a significant price reduction of entecavir (ETV), tenofovir disoproxil fumarate (TDF). This study evaluated the cost-effectiveness of ETV, TDF, and Tenofovir alafenamide (TAF) with or without NVBPP treatment of CHB in China from a social perspective. Methods A state-transition model was founded based on the paraments from published literature to compare treatment strategies involving non-NAs best support care (BSC), ETV, TDF with or without NVBPP, and TAF. A lifetime time cohort was simulated. Outcomes measured were predicted the number of liver-related deaths, costs, quality-adjusted-life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Results Compare to non-NAs BSC, the TAF generated an additional 2.38 QALYs/person at an additional cost of 17899.62USD with an ICER of 7520.85USD/QALY. Following, the TDF generated an additional 2.32 QALYs/person with an ICER of 6,301.84USD/QALY and ETV generated an additional 1.77 QALYs with an ICER of 11,397.28USD/QALY. With NVBPP, the ICER of TDF decreased to -66.38USD/QALY, and ETV decreased to -611.44USD/QALY compared to non-NAs BSC. With willingness-to-pay (WTP) thresholds of 30000USD/QALY, TDF with NVBPP had a 78.29% probability of being the optimal treatment strategy followed by ETV with NVBPP at 14.23% and TAF at 7.48% in the iterations. Conclusion In our analyses, the TDF with NVBPP would be the most cost-effect long-term therapy for CHB, followed by ETV with NVBPP and TAF. The ETV and TDF without NVBPP were cost-effectiveness-dominated.