Servicio de Hepatologia, Hospital General Universitario Valle de Hebron, Paseo Valle de Hebron 119, 08035, Barcelona, Spain.
Pharmacoeconomics. 2013 Jan;31(1):63-75. doi: 10.1007/s40273-012-0009-2.
Chronic hepatitis B is a common, progressive disease, particularly when viral replication is detected. Oral antivirals can suppress viral replication and prevent or delay the development of cirrhosis and liver-related complications.
The aim of this study was to systematically review the quality of cost-effectiveness evidence on first-line treatment with entecavir (ETV) or tenofovir difumarate (TDF) for patients with chronic hepatitis B.
We searched electronic databases and retrieved articles published up to October 2011, in which the cost effectiveness of ETV or TDF was compared with that of other oral antivirals. The quality of the studies identified was assessed with a standard checklist for critical appraisal.
We selected 16 original papers, all published in the last 5 years. There was a conflict of interest in 12 of the 16 studies due to sponsorship by the corresponding pharmaceutical companies. According to the validity assessment, ten studies were classified as high quality. Five studies performed a cost-effectiveness analysis comparing ETV with TDF; they concluded that TDF dominates ETV. The other 11 studies compared ETV or TDF with other strategies; all concluded that ETV and TDF are both cost-effective interventions.
This systematic review shows that there is valid evidence suggesting that ETV and TDF are cost-effective interventions for the treatment of patients with chronic hepatitis B in many health systems. In countries where both alternatives are available, it appears that TDF dominates ETV. These results could help decision makers and clinicians to understand economic issues regarding the available drugs for first-line treatment of hepatitis B.
慢性乙型肝炎是一种常见的、进展性疾病，尤其当检测到病毒复制时。口服抗病毒药物可以抑制病毒复制，预防或延缓肝硬化和肝脏相关并发症的发生。
本研究旨在系统评价恩替卡韦（ETV）或替诺福韦酯（TDF）一线治疗慢性乙型肝炎患者的成本效益证据质量。
我们检索了电子数据库，并检索了截至 2011 年 10 月发表的文章，其中比较了 ETV 或 TDF 与其他口服抗病毒药物的成本效益。使用标准的关键评估清单评估所确定研究的质量。
我们选择了 16 篇原始论文，全部发表在过去 5 年内。由于相应制药公司的赞助，16 项研究中有 12 项存在利益冲突。根据有效性评估，其中 10 项研究被归类为高质量。有 5 项研究进行了 ETV 与 TDF 的成本效益分析，结论是 TDF 优于 ETV。其他 11 项研究比较了 ETV 或 TDF 与其他策略，结论均为 ETV 和 TDF 均具有成本效益。
本系统评价表明，有有效证据表明，在许多卫生系统中，ETV 和 TDF 是治疗慢性乙型肝炎患者的有效干预措施。在有这两种选择的国家，TDF 似乎优于 ETV。这些结果可以帮助决策者和临床医生了解乙型肝炎一线治疗药物的经济问题。
