Cost-effectiveness of antiviral treatment of chronic hepatitis B in Belgium : Part 1: Literature review and results of a national study

VI, 111 p.ill.1 AIMS AND METHODS 5 -- 1.1 AIMS 5 -- 1.2 METHODS 5 -- 1.3 OVERVIEW OF THE REPORT, PART 1 AND PART 2 5 -- 2 NATURAL HISTORY AND EPIDEMIOLOGY 6 -- 2.1 HEPATITIS B: TRANSITION AND NATURAL EVOLUTION 6 -- 2.1.1 Introduction 6 -- 2.1.2 Natural history of infections with the HBV 6 -- 2.1.3 Methods 8 -- 2.1.4 Results 9 -- 2.2 HBV IN BELGIUM AND SURROUNDING COUNTRIES 12 -- 2.2.1 Introduction and search strategy 12 -- 2.2.2 Epidemiology for Belgium, France, Germany and The Netherlands 12 -- 2.2.3 General Conclusion 16 -- 3 TREATMENT 17 -- 3.1 INDICATIONS FOR TREATMENT 17 -- 3.1.1 Treatment goals 17 -- 3.1.2 Definition of response 17 -- 3.1.3 Treatment options 18 -- 3.1.4 Interferon and pegylated interferon 18 -- 3.1.5 Nucleos(t)ide analogues in HBeAg-positive patients 20 -- 3.1.6 Nucleos(t)ide analogues in HBeAg-negative patients 24 -- 3.1.7 Nucleos(t)ide analogues in patients with cirrhosis or advanced fibrosis 25 -- 3.2 RECOMMENDATIONS FOR THE TREATMENT 28 -- 3.2.1 The BASL 2007 recommendations 28 -- 3.2.2 The EASL 2009 recommendations 28 -- 3.2.3 Treatment strategies 29 -- 3.2.4 Management of antiviral resistance to current NA therapy 31 -- 4 SITUATION IN BELGIUM 38 -- 4.1 HISTORY OF REIMBURSEMENT OF ANTIVIRAL DRUGS 38 -- 4.2 THE PROSPECTIVE STUDY 39 -- 4.2.1 Rationale 39 -- 4.2.2 Objectives 40 -- 4.2.3 Ethics and privacy protection 40 -- 4.2.4 Study design and schedule 41 -- 4.3 RESULTS OF THE STUDY 43 -- 4.3.1 Patient characteristics 43 -- 4.3.2 Estimation of the number of patients by disease stage, visiting a medical specialist for chronic HBV infection in Belgium. 46 -- 4.3.3 Conclusion for situation in Belgium 50 -- 4.3.4 Quality of life results 50 -- 4.3.5 Conclusion for quality of life assessment 52 -- 5 REVIEW OF THE COST-EFFECTIVENESS LITERATURE 53 -- 5.1 METHODS 53 -- 5.1.1 Literature search strategy 53 -- 5.1.2 Selection criteria 53 -- 5.1.3 Selection process 54 -- 5.2 OVERVIEW OF THE ECONOMIC EVALUATIONS - TRANSVERSAL 56 -- 5.2.1 Analytical technique 56 -- 5.2.2 Perspective 56 -- 5.2.3 Time horizon and discount rate 56 -- 5.2.4 Population 57 -- 5.2.5 Interventions 57 -- 5.2.6 Outcomes 58 -- 5.2.7 Effectiveness / modelling 61 -- 5.2.8 Costs 64 -- 5.2.9 Results 65 -- 5.3 OVERVIEW OF THE ECONOMIC EVALUATIONS - INDIVIDUAL 67 -- 5.4 GENERAL DISCUSSION AND CONCLUSIONS 70 -- 6 APPENDIXES 72 -- 7 REFERENCES 9