Back to Browse Journals » ClinicoEconomics and Outcomes Research » Volume 3

A cost-effectiveness analysis of different therapies in patients with chronic hepatitis B in Italy

Authors Giorgio L Colombo, Giovanni B Gaeta, Mauro Viganò, et al

Published 15 February 2011 Volume 2011:3 Pages 37—46


Review by Single-blind

Peer reviewer comments 2

Giorgio L Colombo1,2, Giovanni B Gaeta3, Mauro Viganò4, Sergio Di Matteo2
1University of Pavia, School of Pharmacy, Italy; 2S.A.V.E. Studi Analisi Valutazioni Economiche, Milan, Italy; 3Viral Hepatitis Unit, Second University, Naples, Italy; 4Liver Unit, Ospedale San Giuseppe, Università degli Studi di Milano, Milan, Italy

Introduction: Chronic hepatitis B (CHB) is a prevalent disease associated with high morbidity, mortality, and impact on health care costs. Antiviral therapy is aimed at reducing hepatitis B virus replication in order to limit progressive liver disease and improve the natural history of the disease. This study estimates the cost-effectiveness of lamivudine, adefovir, telbivudine, entecavir, tenofovir, and pegylated interferon in patients with CHB.
Methods: A Markov model was developed to evaluate the costs and benefits of antivirals in a cohort of patients with CHB (hepatitis B e antigen [HBeAg]-positive and HBeAg-negative) and cirrhosis over a period of 10 years. Different rescue therapies were considered, according to current guidelines. Data on efficacy and changes in quality of life were derived from clinical trials and epidemiological Italian data. Direct costs were assessed from the perspective of the Italian National Health Service.
Results: Tenofovir was associated with lower costs and higher efficacy compared with entecavir, telbivudine, and adefovir, as shown by their incremental cost-effectiveness ratios (ICER) per quality-adjusted life-year (QALY) gained: tenofovir €30,959, entecavir €45,971, telbivudine €62,051, and adefovir €82,824. Even following 1 year of pegylated interferon therapy, tenofovir had a more favourable ICER per QALY gained compared with the other rescue options. The analysis of patients with cirrhosis confirms the results obtained with the CHB cohort though with higher ICERs. Sensitivity analyses on the main variables confirm the results of the base case scenario.
Conclusion: Within the Italian health care system, in patients with CHB, tenofovir is a cost-effective strategy compared with other available therapies. Public health care authorities would benefit from mathematical models designed to estimate the future burden of CHB infection together with the impact of treatment and drug resistance.

Keywords: chronic hepatitis B, Markov model, cost-effectiveness, lamivudine, adefovir, telbivudine, entecavir, tenofovir, pegylated interferon

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]


Other articles by this author:

Patterns of treatment and costs of intermediate and advanced hepatocellular carcinoma management in four Italian centers

Colombo GL, Cammà C, Attili AF, Ganga R, Gaeta GB, Brancaccio G, Franzini JM, Volpe M, Turchetti G

Therapeutics and Clinical Risk Management 2015, 11:1603-1612

Published Date: 19 October 2015

Cost-effectiveness analysis of antiretroviral therapy in a cohort of HIV-infected patients starting first-line highly active antiretroviral therapy during 6 years of observation

Maggiolo F, Colombo GL, Di Matteo S, Bruno GM, Astuti N, Di Filippo E, Masini G, Bernardini C

Patient Related Outcome Measures 2015, 6:53-60

Published Date: 17 February 2015

Economic and outcomes consequences of TachoSil®: a systematic review

Colombo GL, Bettoni D, Di Matteo S, Grumi C, Molon C, Spinelli D, Mauro G, Tarozzo A, Bruno GM

Vascular Health and Risk Management 2014, 10:569-576

Published Date: 10 September 2014

Economic evaluation of initial antiretroviral therapy for HIV-infected patients: an update of Italian guidelines

Colombo GL, Matteo SD, Antinori A, Medaglia M, Murachelli S, Rizzardini G

ClinicoEconomics and Outcomes Research 2013, 5:489-496

Published Date: 3 October 2013

A cost-of-illness study of spina bifida in Italy

Colombo GL, Di Matteo S, Vinci M, Gatti C, Pascali MP, De Gennaro M, Macrellino E, Mosiello G, Redaelli T, Schioppa F, Dieci C

ClinicoEconomics and Outcomes Research 2013, 5:309-316

Published Date: 2 July 2013

Cost and appropriateness of treating asthma with fixed-combination drugs in local health care units in Italy

Ruggeri I, Bragato D, Colombo GL, Valla E, Di Matteo S

ClinicoEconomics and Outcomes Research 2012, 4:375-382

Published Date: 5 December 2012

Cost-effectiveness analysis of HIV treatment in the clinical practice of a public hospital in northern Italy

Rizzardini G, Bonfanti P, Carenzi L, Coen M, Orlando G, Di Matteo S, Colombo GL

Therapeutics and Clinical Risk Management 2012, 8:377-384

Published Date: 17 September 2012

Antidiabetic therapy in real practice: indicators for adherence and treatment cost

Colombo GL, Rossi E, De Rosa M, Benedetto D, Gaddi AV

Patient Preference and Adherence 2012, 6:653-661

Published Date: 14 September 2012

Burden of Crohn’s disease: economics and quality of life aspects in Italy

Benedini V, Caporaso N, Corazza GR, Rossi Z, Fornaciari G, Cottone M, Frosini G, Caruggi M, Ottolini C, Colombo GL

ClinicoEconomics and Outcomes Research 2012, 4:209-218

Published Date: 24 July 2012

Acamprosate in the treatment of alcoholism: a budget impact analysis for the National Health Service in Italy

Colombo GL, Di Matteo S, Bruno G

Substance Abuse and Rehabilitation 2012, 3:73-79

Published Date: 17 July 2012

Cost-effectiveness analysis of initial HIV treatment under Italian guidelines

Colombo GL, Colangeli V, Di Biagio A, Di Matteo S, Viscoli C, Viale P

ClinicoEconomics and Outcomes Research 2011, 3:197-205

Published Date: 31 October 2011

Cost–utility analysis of prophylaxis versus treatment on demand in severe hemophilia A

Giorgio L Colombo, Sergio Di Matteo, Maria Elisa Mancuso, et al

ClinicoEconomics and Outcomes Research 2011, 3:55-61

Published Date: 14 March 2011

A cost–utility analysis of etanercept for the treatment of moderate-to-severe psoriasis in Italy

Giorgio L Colombo, Sergio Di Matteo, Ketty Peris, Maria Concetta Fargnoli, et al.

ClinicoEconomics and Outcomes Research 2009, 1:53-59

Published Date: 15 October 2009

An economic evaluation of aripiprazole vs olanzapine adapted to the Italian setting using outcomes of metabolic syndrome and risk for diabetes in patients with schizophrenia

Giorgio L Colombo, Mauro Caruggi, Sergio Di Matteo, Alessandro Rossi

Neuropsychiatric Disease and Treatment 2008, 4:967-976

Published Date: 10 October 2008

Assessment of acceptability and ease of use of atovaquone/proguanil medication in subjects undergoing malaria prophylaxis

V Nicosia, Giorgio Colombo, M Consentino, S Di Matteo, F Mika, et al

Therapeutics and Clinical Risk Management 2008, 4:1105-1110

Published Date: 10 October 2008

Moderate and severe plaque psoriasis: cost-of-illness study in Italy

GL Colombo, GF Altomare, K Peris, P Martini, G Quarta

Therapeutics and Clinical Risk Management 2008, 4:559-568

Published Date: 11 April 2008

Candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) and resource utilization and costs in Italy

Giorgio L Colombo, Mauro Caruggi, Chiara Ottolini, Aldo P Maggioni

Vascular Health and Risk Management 2008, 4:223-234

Published Date: 8 February 2008

Readers of this article also read:

Emerging and future therapies for hemophilia

Carr ME, Tortella BJ

Journal of Blood Medicine 2015, 6:245-255

Published Date: 3 September 2015

A new recombinant factor VIII: from genetics to clinical use

Santagostino E

Drug Design, Development and Therapy 2014, 8:2507-2515

Published Date: 12 December 2014

Second case report of successful electroconvulsive therapy for a patient with schizophrenia and severe hemophilia A

Saito N, Shioda K, Nisijima K, Kobayashi T, Kato S

Neuropsychiatric Disease and Treatment 2014, 10:865-867

Published Date: 16 May 2014

Green synthesis of water-soluble nontoxic polymeric nanocomposites containing silver nanoparticles

Prozorova GF, Pozdnyakov AS, Kuznetsova NP, Korzhova SA, Emel’yanov AI, Ermakova TG, Fadeeva TV, Sosedova LM

International Journal of Nanomedicine 2014, 9:1883-1889

Published Date: 16 April 2014

Cross-linked acrylic hydrogel for the controlled delivery of hydrophobic drugs in cancer therapy

Deepa G, Thulasidasan AK, Anto RJ, Pillai JJ, Kumar GS

International Journal of Nanomedicine 2012, 7:4077-4088

Published Date: 27 July 2012

Particle size reduction to the nanometer range: a promising approach to improve buccal absorption of poorly water-soluble drugs

Rao S, Song Y, Peddie F, Evans AM

International Journal of Nanomedicine 2011, 6:1245-1251

Published Date: 20 June 2011

Crystallization after intravitreal ganciclovir injection

Pitipol Choopong, Nattaporn Tesavibul, Nattawut Rodanant

Clinical Ophthalmology 2010, 4:709-711

Published Date: 14 July 2010