Cost-effectiveness of Treatment of Chronic Hepatitis B in China: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

SUN Xin ¹ , YANG Huan ² , WANG Li ¹ , Ewa Orlewska ³ , Li Youping ¹

1. Chinese Evidence-Based Medicine Center,West China Hospital,Sichuan University,Chengdu 610041,China2. Center for Drug Evaluation,State Food and Drug Administration,China3. Center for Pharmacoeconomics,Warsaw,Poland;

Corresponding author：

Keywords：

Systematic review; Economic evaluations in health care; Hepatitis B

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Objective 　To critically appraise and systematically reviewe the economic evaluations of all alternative interventions for hepatitis B in China.
Methods 　We searched MEDLINE and the four largest Chinese electronic databases. The references of eligible studies were also screened. Economic evaluations of any type, which studied interventions for hepatitis B, were eligible for inclusion. A 25-item quality checklist modified from a BMJ checklist was used to appraise the quality of studies. The overall quality score was calculated against 100 points to indicate the risk of bias. Quality appraisal and data extraction were conducted by two independent reviewers.
Results 　Nineteen full economic evaluations and two cost studies were included of which fourteen studies were scored 25-44 points, and seven scored 45-61 points. Most studies adequately documented effectiveness of interventions. However, the costs of interventions were not well reported in over 50% of studies. Many studies inadequately conducted data analysis, particular in sensitivity analysis and discounting. Ten studies compared lamivudine with interferon or conventional therapy for 1-year (or 6-month) effects, which indicated that lamivudine was generally cost-effective. Three evaluations studied 30-year outcomes of interferon compared with conventional therapy, which suggested that interferon usually saved additional costs and years of life. Another three studies compared interferon with less frequently used antiviral agents, however the comparative cost-effectiveness varied. Two cost studies showed the total costs and the percentage of medical costs increased rapidly in proportion to disease severity.
Conclusions 　Of alternative interventions, lamivudine is cost effective for short-term effects. Interferon is superior to conventional therapy for long-term outcomes. However, the long-term economic outcomes cannot be justified by the current evidence. Quality of methods, particularly, that of costing and analytical methods, is a major limitation. There remains a b need to improve the quality of reporting. Careful considerations should be paid before applying the results to decision making.

Citation： SUN Xin,YANG Huan,WANG Li,Ewa Orlewska,Li Youping. Cost-effectiveness of Treatment of Chronic Hepatitis B in China: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2005, 05(11): 833-845. doi: Copy

1.	Kao JH, Chen DS. Global control of hepatitis B virus infection[J]. Lancet Infect Dis, 2002; 2(7): 395-403.
2.	Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN, Hasnian SS, Leung N, Lesmana L, Phiet PH, Sjalfocleah Noer HM, Sollano J, Sun HS, Xu DZ. Chronic hepatitis B virus infection in Asian countries[J]. J Gastroenterol Hepatol, 2000; 15(12): 1356-1361.
3.	Reported Incidence and Death Rate of Infectious Diseases. The 2004 Statistical Reports of Ministry of Health, China. Available at: http://61.49.18.68/statistics/digest04/s73.htm.
4.	Reproted Incidence and Death Rate of 27 Infectious Diseases in 2003. The 2004 Statistical Reports of Ministry of Health, China. Available at: http://61.49.18.68/statistics/digest04/s74.htm.
5.	Sun ZT, Ming LH, Zhu X, Lu JH. Prevention and Control of Hepatitis B in China[J]. Journal of Medical Virology, 2002; 67(3): 447-450.
6.	Liu ZQ, Zhao SL, Zhang YX, Ma MG, Wang H. Cost-benefit analysis on immunization of onewborns with hepatitis B vaccination in Jinan City[J]. Chinese Journal of Epidemiology, 1995; 16(2): 81-84.
7.	Qi YL , Wang FZ ,Gong XH. Analysis on cost-benefit it for infant hepatitis B vaccine immunization strategy in Beijing[J]. Chin J Public Health, 2004; 20(9): 1067-1069.
8.	Broderick AL, Jonas MM. Hepatitis B in children[J]. Semin Liver Dis, 2003; 23(1): 59-68.
9.	Maddrey WC. Hepatitis B: An Important Public Health Issue[J]. Journal of Medical Virology, 2000; 61: 362-366.
10.	ILiaw YF. Management of patients with chronic hepatitis B[J]. Journal of Gastroenterology and Hepatology, 2002; 17: 406-408.
11.	Song HY, Wang WZ, Zhu JR. Therapeutic effect of valsartan on chronic type B hepatitis and liver cirrhosis[J]. World Chinese J Digestol, 2004; 12(5): 1085-1088.
12.	Li X, Guo JC. Efficacy of Lamivudine in Treating Chronic Serious-type Hepatitis[J]. Zhong Xi Yi Jie He Gan Bing Za Zhi, 2002; 12(3): 134-135.
13.	Guan R. Interferon monotherapy in chronic hepatitis B[J]. J Gastroenterol Hepatol, 2000; 15(Suppl.): E34-40.
14.	Lau GKK. Use of immunomodulatory therapy (other than interferon) for the treatment of chronic hepatitis B virus infection[J]. J Gastroenterol Hepatol, 2000; 15(Suppl.): E46-52.
15.	Leung N. Nucleoside analogues in the treatment of chronic hepatitis B[J]. J Gastroenterol Hepatol, 2000; 15(Suppl.): E53-60.
16.	Matthews GV, Nelson MR. The management of chronic hepatitis B infection[J]. International Journal of STD & AIDS, 2001; 12(6): 353-357.
17.	Malaguarnera M, Restuccia S, Receputo G, Giugno I, Pistone G, Trovato BA. The efficacy of interferon alfa in chronic hepatitis B: a review and meta-analysis[J]. Current Therapeutic Research, 1996; 57(9): 646-662.
18.	Mutchnick MG, Appelman HD, Chung HT. Thymosin treatment of chronic hepatitis B: a placebo-controlled pilot trial[J]. Hepatology, 1991; 14(3): 409-415.
19.	Drummond M, OBrein B, Stoddart G, Torrance G. Methods of Economic Evaluation of Health Care Programmes. 2nd ed. New York, NY, Oxford University Press Inc; 1997.
20.	Drummond MF, Jefferson TO, for the MBJ Working Party. Guidelines for authors and peer-reviewers of economic submissions to the British Medical Journal[J]. BMJ, 1996; 313: 275-283.
21.	Weistein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the Panel on Cost-effectiveness in Health and Medicine[J]. JAMA, 1996; 276: 1253-1258.
22.	Fang SY. Li YG, Su JK, Xu DZ, Long Y, Jin J. Investigation of Cost Caused by Hepatitis B in the Army[J]. Chinese Hospital Statistics, 2000; 7(4): 206-209.
23.	Fu HL, Chen XB. Chronic hepatitis B virus infectorsp use of medical services and the expenses incurred[J]. Chinese Journal of Hospital Management, 2004; 20(7): 408-409.
24.	He H, Yuan GL. Comparing the effect and economic effectiveness of Interferon alfa21b and Lamivudine in treating chronic hepatitis B[J]. Guangdong Pharmacy, 2002; 12(5): 52-53.
25.	Wu LL, Liu CX, Ying XF. The analysis of effectiveness and cost of lamivudine in treatment of chronic hepatitis[J]. Chinese Journal of New Drugs, 2002; 11(10): 811-813.
26.	Wang RL, Ye XG. A Comparison of Cost-effectiveness between Interferon α-2b and Lamivudine in Treating Chronic Hepatitis B[J]. Evaluation and Analysis of Drug-use in Hospitals of China, 2002; 2(1): 26-27.
27.	Yan JZ. Cost effectiveness analysis of interferon a-1b with lamivudine for the treatment of chronic hepatitis B[J]. Guo Ji Yi Yao Wei Sheng Dao Bao, 2004; 10(8): 58-59.
28.	Yang ZH. Chen YH. Cost-effectiveness analysis of three treatment protocols for hepatitis B[J]. Academic Journal of Guangdong Coll Ege of Pharmacy, 2001; 17(2): 135-136.
29.	Zhang H, Wang RS, Zhang J, Kong HW, Zhu YF, Fu HB. Cost-effectiveness analysis of antiviral therapies for chronic hepatitis B[J]. Lin Chuang Hui Cui, 2002; 17(8): 441-442.
30.	Zhang XF, Lan ZL. Cost-effectiveness analysis of two treatment protocols for chronic hepatitis B[J]. Modern Medicine, 2003; 19(7): 823.
31.	Zhou XQ, Wang NS, Meng J. Studying Pharmacoeconomics of Interferon Cures the Chronic Hepatitis B[J]. Journal of Mathematical Medicine, 2004; 17(4): 348-349.
32.	Lin XM, Xu ZY, Zhao SJ. Pharmaco-economic study: interferon alfa treatment of chronic hepatitis B in Shanghai[J]. Chinese Journal of Clinical Pharmacy, 1997; 6(4): 173-173.
33.	Lin XM, Ding D, Zhang PH, Zhang Y, Wei D, Liu W, et al. Cost-effectiveness analysis of treatment of chronic hepatitis B with interferon in Chinese City[J]. Chin J Hepatol, 1999; 7(2): 84-87.
34.	Liu LP, He CS. Cost effectiveness of interferon in the treatment of chronic hepatitis B[J]. Chinese New Drugs Journal, 1999; 8(5): 332-334.
35.	Wang YZ. Cost-effectiveness analysis of three treatment protocols for chronic hepatitis B[J]. Zhong Xi Yi Jie He Gan Bing Za Zhi, 2003; 13(5): 307-309.
36.	Yao GB, Wang BE. Economic analysis of recombinant interferon alpha-2b in thetreatment of chronic hepatitis B and chronic hepatitis C[J]. Chin J of Dig, 1999; 19(6): 369-374.
37.	Yuan XB. A Comparison of Cost-effectiveness between Compound G lycyrrhizin and Interferon A21b in Treating Chronic Hepatitis B[J]. Strait Pharmaceutical Journal, 2004; 16(1): 99-101.
38.	Yin T, Liu SH. Comparison of therapeutic effects and cost-effectiveness analysis of foscarnet and a-interferon for chronic hepatitis B[J]. Evaluation and Analysis of Drug-Use in Hospitals of China, 2002; 2(5): 282-283.
39.	Chen XB, Alison T, Larry L, Saal GB. Cost-effectiveness analysis after treatment of chronic hepatitis B with Lamivudine[J]. Chinese Health Resources, 2003; 6(5): 228-230.
40.	Wei HY. Application of cost-effectiveness analysis in three therapeutic schemes for chronic hepatitis B[J]. China Pharmacy, 2001; 11(6): 264-265.
41.	Guo WP. Cost-effectiveness analysis of 4 therapeutic projects for chronic hepatitis B[J]. Evaluation and Analysis of Drug-use in Hospitals of China, 2003; 3(4): 227-228.
42.	Zhang YE. Cost-effectiveness analysis of four regimens for chronic hepatitis B[J]. Academic Journal of Guangdong College of Pharmacy, 1999; 15(4): 307-309.
43.	Gitlin N. Hepatitis B: diagnosis, prevention, and treatment[J]. Clinical Chemistry, 1997; 43: 8(B): 1500-1506.
44.	Di Bisceglie AM, Fong TL, Fried MW, Swain MG, Bergasa NV, Axiotis CA, Waggoner JG, Park Y, Hoofnagle JH. A randomized, controlled trial of recombinant alpha-interferon therapy for chronic hepatitis B[J]. Am J Gastroenterol, 1993; 88(11): 1887-1892.
45.	Fried MR, Hoofnagle J. Therapy of hepatitis C[J]. Semin Liver Dis, 1995; 15: 82-91.
46.	Lai CL, Chien RN, Leung NW, Chang TT, Guan R, Tai DI, Ng KY, Wu PC, Dent JC, Barber J, Stephenson SL, Gray DF. A One-year Trial of Lamivudine for Chronic Hepatitis B. Asia Hepatitis Lamivudine Stuly Group[J]. N Engl J of Med, 1998; 339(2): 61-68.
47.	Dienstag JL, Schieff ER, Wright TL, Perrillo RP, Hann HW, Goodman Z, Crowther L, Condreay LD, Woessner M, Rubin M, Brown NA. Lamivudine as Initial Treatment for Chronic Hepatitis B in the United States[J]. N Engl J Med, 1999; 341(17): 1256-1263.
48.	Malik AH, Lee WM. Chronic Hepatitis B Virus Infection: Treatment Strategies for the Next Millennium[J]. Ann Intern Med, 2000; 132(9): 723-731.
49.	Crowley SJ,Tognarini D,D esmond PV, Lees M. Cost-Effectiveness Analysis of Lamivudine for the Treatment of Chronic Hepatitis B[J]. Pharmacoeconomics, 2000; 17(5): 409-427.
50.	Wong JB, Koff RS, Tine F, Pauker SG. Cost-effectiveness of Interferon-alpha2b Treatment for Hepatitis B e Antigen-Positive Chronic Hepatitis B[J]. Annals of Internal Medicine, 1995; 122(9): 664-675.
51.	Brooks EA, LaceyLF, Payne SL, Miller DM. Economic Evaluation of Lamivudine Compared with Interferon-a B in the Treatment of Chronic Hepatitis B in the United States[J]. Am J Manag Care, 2001; 7(7): 677-682.
52.	Crowley S, Tognarini D, Desmond P, Lees M, Saal G. Introduction of lamivudine for the treatment of chronic hepatitis B: Expected clinical and economic outcomes based on 4-year clinical trial data[J]. Journal of Gastroenterology and Hepatology, 2002; 17(2): 153-164.
53.	Janssen Ha, Gerken G, Carreno V, Marcellin P, Naoumov NV, Craxi A, Ring-Larsen H, Kitis G, Van Hatlum J, de Dries RA, Michielsen PP, ten Kate FJ, Hop WC, Heijtink RA, Honkoop P, Schalm SW. Interferon Alfa for Chronic Hepatitis B Infection: Increased Efficacy of Prolonged Treatment[J]. Hepatology, 1999; 30(1): 238-243.
54.	Lampertico P, Del Ninno E, Manzin A, Donato MF, Rumi MG, Lunghi G, Morabito A, Clementi M, Colombo M. A Randomized, Controlled Trial of a 24-Month Course of Interferon Alfa 2b in Patients With Chronic Hepatitis B Who Had Hepatitis B Virus DNA Without Hepatitis B e Antigen in Serum[J]. Hepatology, 1997; 26(6): 1621-1625.

1. Kao JH, Chen DS. Global control of hepatitis B virus infection[J]. Lancet Infect Dis, 2002; 2(7): 395-403.
2. Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN, Hasnian SS, Leung N, Lesmana L, Phiet PH, Sjalfocleah Noer HM, Sollano J, Sun HS, Xu DZ. Chronic hepatitis B virus infection in Asian countries[J]. J Gastroenterol Hepatol, 2000; 15(12): 1356-1361.
3. Reported Incidence and Death Rate of Infectious Diseases. The 2004 Statistical Reports of Ministry of Health, China. Available at: http://61.49.18.68/statistics/digest04/s73.htm.
4. Reproted Incidence and Death Rate of 27 Infectious Diseases in 2003. The 2004 Statistical Reports of Ministry of Health, China. Available at: http://61.49.18.68/statistics/digest04/s74.htm.
5. Sun ZT, Ming LH, Zhu X, Lu JH. Prevention and Control of Hepatitis B in China[J]. Journal of Medical Virology, 2002; 67(3): 447-450.
6. Liu ZQ, Zhao SL, Zhang YX, Ma MG, Wang H. Cost-benefit analysis on immunization of onewborns with hepatitis B vaccination in Jinan City[J]. Chinese Journal of Epidemiology, 1995; 16(2): 81-84.
7. Qi YL , Wang FZ ,Gong XH. Analysis on cost-benefit it for infant hepatitis B vaccine immunization strategy in Beijing[J]. Chin J Public Health, 2004; 20(9): 1067-1069.
8. Broderick AL, Jonas MM. Hepatitis B in children[J]. Semin Liver Dis, 2003; 23(1): 59-68.
9. Maddrey WC. Hepatitis B: An Important Public Health Issue[J]. Journal of Medical Virology, 2000; 61: 362-366.
10. ILiaw YF. Management of patients with chronic hepatitis B[J]. Journal of Gastroenterology and Hepatology, 2002; 17: 406-408.
11. Song HY, Wang WZ, Zhu JR. Therapeutic effect of valsartan on chronic type B hepatitis and liver cirrhosis[J]. World Chinese J Digestol, 2004; 12(5): 1085-1088.
12. Li X, Guo JC. Efficacy of Lamivudine in Treating Chronic Serious-type Hepatitis[J]. Zhong Xi Yi Jie He Gan Bing Za Zhi, 2002; 12(3): 134-135.
13. Guan R. Interferon monotherapy in chronic hepatitis B[J]. J Gastroenterol Hepatol, 2000; 15(Suppl.): E34-40.
14. Lau GKK. Use of immunomodulatory therapy (other than interferon) for the treatment of chronic hepatitis B virus infection[J]. J Gastroenterol Hepatol, 2000; 15(Suppl.): E46-52.
15. Leung N. Nucleoside analogues in the treatment of chronic hepatitis B[J]. J Gastroenterol Hepatol, 2000; 15(Suppl.): E53-60.
16. Matthews GV, Nelson MR. The management of chronic hepatitis B infection[J]. International Journal of STD & AIDS, 2001; 12(6): 353-357.
17. Malaguarnera M, Restuccia S, Receputo G, Giugno I, Pistone G, Trovato BA. The efficacy of interferon alfa in chronic hepatitis B: a review and meta-analysis[J]. Current Therapeutic Research, 1996; 57(9): 646-662.
18. Mutchnick MG, Appelman HD, Chung HT. Thymosin treatment of chronic hepatitis B: a placebo-controlled pilot trial[J]. Hepatology, 1991; 14(3): 409-415.
19. Drummond M, OBrein B, Stoddart G, Torrance G. Methods of Economic Evaluation of Health Care Programmes. 2nd ed. New York, NY, Oxford University Press Inc; 1997.
20. Drummond MF, Jefferson TO, for the MBJ Working Party. Guidelines for authors and peer-reviewers of economic submissions to the British Medical Journal[J]. BMJ, 1996; 313: 275-283.
21. Weistein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the Panel on Cost-effectiveness in Health and Medicine[J]. JAMA, 1996; 276: 1253-1258.
22. Fang SY. Li YG, Su JK, Xu DZ, Long Y, Jin J. Investigation of Cost Caused by Hepatitis B in the Army[J]. Chinese Hospital Statistics, 2000; 7(4): 206-209.
23. Fu HL, Chen XB. Chronic hepatitis B virus infectorsp use of medical services and the expenses incurred[J]. Chinese Journal of Hospital Management, 2004; 20(7): 408-409.
24. He H, Yuan GL. Comparing the effect and economic effectiveness of Interferon alfa21b and Lamivudine in treating chronic hepatitis B[J]. Guangdong Pharmacy, 2002; 12(5): 52-53.
25. Wu LL, Liu CX, Ying XF. The analysis of effectiveness and cost of lamivudine in treatment of chronic hepatitis[J]. Chinese Journal of New Drugs, 2002; 11(10): 811-813.
26. Wang RL, Ye XG. A Comparison of Cost-effectiveness between Interferon α-2b and Lamivudine in Treating Chronic Hepatitis B[J]. Evaluation and Analysis of Drug-use in Hospitals of China, 2002; 2(1): 26-27.
27. Yan JZ. Cost effectiveness analysis of interferon a-1b with lamivudine for the treatment of chronic hepatitis B[J]. Guo Ji Yi Yao Wei Sheng Dao Bao, 2004; 10(8): 58-59.
28. Yang ZH. Chen YH. Cost-effectiveness analysis of three treatment protocols for hepatitis B[J]. Academic Journal of Guangdong Coll Ege of Pharmacy, 2001; 17(2): 135-136.
29. Zhang H, Wang RS, Zhang J, Kong HW, Zhu YF, Fu HB. Cost-effectiveness analysis of antiviral therapies for chronic hepatitis B[J]. Lin Chuang Hui Cui, 2002; 17(8): 441-442.
30. Zhang XF, Lan ZL. Cost-effectiveness analysis of two treatment protocols for chronic hepatitis B[J]. Modern Medicine, 2003; 19(7): 823.
31. Zhou XQ, Wang NS, Meng J. Studying Pharmacoeconomics of Interferon Cures the Chronic Hepatitis B[J]. Journal of Mathematical Medicine, 2004; 17(4): 348-349.
32. Lin XM, Xu ZY, Zhao SJ. Pharmaco-economic study: interferon alfa treatment of chronic hepatitis B in Shanghai[J]. Chinese Journal of Clinical Pharmacy, 1997; 6(4): 173-173.
33. Lin XM, Ding D, Zhang PH, Zhang Y, Wei D, Liu W, et al. Cost-effectiveness analysis of treatment of chronic hepatitis B with interferon in Chinese City[J]. Chin J Hepatol, 1999; 7(2): 84-87.
34. Liu LP, He CS. Cost effectiveness of interferon in the treatment of chronic hepatitis B[J]. Chinese New Drugs Journal, 1999; 8(5): 332-334.
35. Wang YZ. Cost-effectiveness analysis of three treatment protocols for chronic hepatitis B[J]. Zhong Xi Yi Jie He Gan Bing Za Zhi, 2003; 13(5): 307-309.
36. Yao GB, Wang BE. Economic analysis of recombinant interferon alpha-2b in thetreatment of chronic hepatitis B and chronic hepatitis C[J]. Chin J of Dig, 1999; 19(6): 369-374.
37. Yuan XB. A Comparison of Cost-effectiveness between Compound G lycyrrhizin and Interferon A21b in Treating Chronic Hepatitis B[J]. Strait Pharmaceutical Journal, 2004; 16(1): 99-101.
38. Yin T, Liu SH. Comparison of therapeutic effects and cost-effectiveness analysis of foscarnet and a-interferon for chronic hepatitis B[J]. Evaluation and Analysis of Drug-Use in Hospitals of China, 2002; 2(5): 282-283.
39. Chen XB, Alison T, Larry L, Saal GB. Cost-effectiveness analysis after treatment of chronic hepatitis B with Lamivudine[J]. Chinese Health Resources, 2003; 6(5): 228-230.
40. Wei HY. Application of cost-effectiveness analysis in three therapeutic schemes for chronic hepatitis B[J]. China Pharmacy, 2001; 11(6): 264-265.
41. Guo WP. Cost-effectiveness analysis of 4 therapeutic projects for chronic hepatitis B[J]. Evaluation and Analysis of Drug-use in Hospitals of China, 2003; 3(4): 227-228.
42. Zhang YE. Cost-effectiveness analysis of four regimens for chronic hepatitis B[J]. Academic Journal of Guangdong College of Pharmacy, 1999; 15(4): 307-309.
43. Gitlin N. Hepatitis B: diagnosis, prevention, and treatment[J]. Clinical Chemistry, 1997; 43: 8(B): 1500-1506.
44. Di Bisceglie AM, Fong TL, Fried MW, Swain MG, Bergasa NV, Axiotis CA, Waggoner JG, Park Y, Hoofnagle JH. A randomized, controlled trial of recombinant alpha-interferon therapy for chronic hepatitis B[J]. Am J Gastroenterol, 1993; 88(11): 1887-1892.
45. Fried MR, Hoofnagle J. Therapy of hepatitis C[J]. Semin Liver Dis, 1995; 15: 82-91.
46. Lai CL, Chien RN, Leung NW, Chang TT, Guan R, Tai DI, Ng KY, Wu PC, Dent JC, Barber J, Stephenson SL, Gray DF. A One-year Trial of Lamivudine for Chronic Hepatitis B. Asia Hepatitis Lamivudine Stuly Group[J]. N Engl J of Med, 1998; 339(2): 61-68.
47. Dienstag JL, Schieff ER, Wright TL, Perrillo RP, Hann HW, Goodman Z, Crowther L, Condreay LD, Woessner M, Rubin M, Brown NA. Lamivudine as Initial Treatment for Chronic Hepatitis B in the United States[J]. N Engl J Med, 1999; 341(17): 1256-1263.
48. Malik AH, Lee WM. Chronic Hepatitis B Virus Infection: Treatment Strategies for the Next Millennium[J]. Ann Intern Med, 2000; 132(9): 723-731.
49. Crowley SJ,Tognarini D,D esmond PV, Lees M. Cost-Effectiveness Analysis of Lamivudine for the Treatment of Chronic Hepatitis B[J]. Pharmacoeconomics, 2000; 17(5): 409-427.
50. Wong JB, Koff RS, Tine F, Pauker SG. Cost-effectiveness of Interferon-alpha2b Treatment for Hepatitis B e Antigen-Positive Chronic Hepatitis B[J]. Annals of Internal Medicine, 1995; 122(9): 664-675.
51. Brooks EA, LaceyLF, Payne SL, Miller DM. Economic Evaluation of Lamivudine Compared with Interferon-a B in the Treatment of Chronic Hepatitis B in the United States[J]. Am J Manag Care, 2001; 7(7): 677-682.
52. Crowley S, Tognarini D, Desmond P, Lees M, Saal G. Introduction of lamivudine for the treatment of chronic hepatitis B: Expected clinical and economic outcomes based on 4-year clinical trial data[J]. Journal of Gastroenterology and Hepatology, 2002; 17(2): 153-164.
53. Janssen Ha, Gerken G, Carreno V, Marcellin P, Naoumov NV, Craxi A, Ring-Larsen H, Kitis G, Van Hatlum J, de Dries RA, Michielsen PP, ten Kate FJ, Hop WC, Heijtink RA, Honkoop P, Schalm SW. Interferon Alfa for Chronic Hepatitis B Infection: Increased Efficacy of Prolonged Treatment[J]. Hepatology, 1999; 30(1): 238-243.
54. Lampertico P, Del Ninno E, Manzin A, Donato MF, Rumi MG, Lunghi G, Morabito A, Clementi M, Colombo M. A Randomized, Controlled Trial of a 24-Month Course of Interferon Alfa 2b in Patients With Chronic Hepatitis B Who Had Hepatitis B Virus DNA Without Hepatitis B e Antigen in Serum[J]. Hepatology, 1997; 26(6): 1621-1625.

Chinese Journal of Evidence-Based Medicine

Cost-effectiveness of Treatment of Chronic Hepatitis B in China: A Systematic Review

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