For patients with Hepatitis B virus infection in the immune tolerant phase, the current standard of care is to not to offer treatment.
However, the recent Risk Evaluation of the Viral Load Elevation and Associated Liver Disease/Cancer-In study results show a striking relationship between high Hepatitis B virus DNA levels and risk for hepatocellular carcinoma and cirrhosis.
Dr Reddy and colleagues from Philadelphia, USA undertook a cost effectiveness analysis to assess whether immune tolerant patients with high Hepatitis B virus DNA levels should undergo treatment.
|Lamivudine cost $5784 per quality adjusted life year gained in males|
|Alimentary Pharmacology & Therapeutic|
The team created a lifetime Markov model to evaluate the cost-effectiveness of 2 strategies for immune tolerant Hepatitis B.
The first strategy included Hepatitis B virus DNA suppression with limousine, and the second included no treatment.
Patients cycled between viral suppression, ongoing viremia, seroconversion, hepatocellular carcinoma, cirrhosis and death.
The researchers compared these with the no treatment strategy.
The team found that lamivudine therapy was more expensive but more cost-effective with an additional cost of $5784 and $12,584 per quality adjusted life year gained in males and females, respectively.
Treatment resulted in a gain in life expectancy and a decrease in lifetime risk of hepatocellular carcinoma and cirrhosis.
Dr Reddy's team concluded, "Suppressing Hepatitis B virus DNA to prevent hepatocellular carcinoma and cirrhosis in immune tolerant patients is very cost-effective, and treatment of these patients may be considered."
"Future prospective clinical trials will need to be undertaken to confirm our findings."