Cost-effectiveness of interferon-alpha 2b treatment for hepatitis B e antigen-positive chronic hepatitis B.

OBJECTIVE To estimate the cost-effectiveness of interferon-alpha 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-alpha 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-alpha 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-alpha 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-alpha 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-alpha 2b should prolong life and lower costs for patients with chronic hepatitis B who are HBeAg positive.