Pegylated interferon alfa-2a monotherapy is cost-effective for Hepatitis D in Canadian immigrants, despite bulevirtide's clinical edge.
Background
Chronic Hepatitis D Virus (HDV) infection, often co-occurring with Hepatitis B, carries high mortality rates, particularly among immigrants from high-endemic regions. In Canada, immigrants represent 23% of the population and face barriers to screening and treatment, leading to poorer outcomes. Current treatment options aim to suppress viral replication and prevent liver disease progression, but their cost-effectiveness in specific populations like Canadian immigrants, especially with newer agents like bulevirtide, remains a critical gap for public health policy.
Study Design
Researchers conducted a cost-utility analysis from a public-payer perspective over a lifetime horizon, using a 1.5% annual discount rate for costs in 2023 Canadian dollars. A state-transition model, developed in TreeAge Pro, simulated the natural progression of chronic hepatitis B and D. Three interventions were compared: screening and treatment with bulevirtide; screening and treatment with pegylated interferon alfa-2a; and screening and treatment with both bulevirtide and pegylated interferon alfa-2a (combination therapy). The primary endpoint was the incremental cost-effectiveness ratio (ICER), with sensitivity analyses performed.
Results
All three screening and treatment strategies significantly reduced cases of decompensated cirrhosis, hepatocellular carcinoma (HCC), and liver-related death compared to no screening. Combination therapy with bulevirtide and pegylated interferon alfa-2a demonstrated the most favorable clinical outcomes, suggesting superior efficacy in preventing disease progression. However, when considering cost-effectiveness, only pegylated interferon alfa-2a monotherapy proved to be a cost-effective strategy. > Its ICER was $23,177/QALY, falling within commonly accepted thresholds for cost-effectiveness in Canada. The study also noted that while combination therapy is likely more clinically effective, it would only become cost-effective if its treatment costs were to decrease significantly, highlighting a current economic barrier to its broader implementation.
Key Findings
- Pegylated interferon alfa-2a monotherapy was the only cost-effective strategy for HDV (ICER: $23,177/QALY).
- All screening and treatment strategies reduced decompensated cirrhosis, HCC, and liver death.
- Combination therapy with bulevirtide and pegylated interferon alfa-2a showed the most favorable clinical outcomes.
- Combination therapy may become cost-effective if its treatment costs decrease significantly.
Why It Matters
This analysis provides crucial economic data for public health policy in Canada, suggesting that pegylated interferon alfa-2a monotherapy is the most fiscally responsible approach for managing Hepatitis D in immigrant populations. For clinicians and policymakers, this means prioritizing pegylated interferon alfa-2a as a first-line cost-effective treatment option, while acknowledging the superior clinical efficacy of combination therapy. Future protocols should consider pegylated interferon alfa-2a monotherapy as the standard of care for cost-effective HDV management in this population. The findings also underscore the need for pharmaceutical companies to lower the cost of newer, more effective drugs like bulevirtide to make them more accessible and cost-effective for broader public health initiatives.
hepatitis d
cost-utility-analysis
pegylated-interferon-alfa-2a
bulevirtide
liver-disease
public-health