Cost-effectiveness of tenofovir alafenamide fumarate for treatment of chronic hepatitis B: Evidence from a tertiary hospital in Vietnam

Background This study aims to evaluate the cost-effectiveness of tenofovir alafenamide fumarate (TAF) versus tenofovir disoproxil fumarate (TDF) for chronic hepatitis B treatment from a payer’s perspective in a limited-income context like Vietnam. Methods A Markov model was developed to estimate the lifetime cost and effectiveness (measured in quality-adjusted life year, QALY) of TAF compared to TDF in the HbeAg+ patient population. Efficacy data came from clinical trials, and costs were based on 2023 data from an exit survey of 94 inpatients and 464 outpatients in Bach Mai hospital. Other clinical data were also sourced from CHB patients at Bach Mai hospital. Along with deterministic analysis, two-way sensitivity analysis, probabilistic sensitivity analysis, threshold, and budget impact analysis were performed. Results Compared to TDF, TAF yielded an additional cost of USD 3,983 and an additional QALY gained of 0.14, resulting in the incremental cost-effectiveness ratio (ICER) of USD 32,090 per QALY gained. The ICER exceeds the cost-effective threshold of three-time gross domestic product (GDP) per capita, that is, USD 11,348, by 2.8 times. According to one-way sensitivity analysis, ICERs were driven mainly by transition probabilities and TDF/ TAF prices. TAF would be cost-effective compared to TDF at the three-time GDP per capital threshold if TAF price were reduced by 33.4%. Conclusions TAF is not cost-effective compared to TDF for treating chronic hepatitis B in HBeAg+ patients. The study offers relevant evidence for policymakers to consider including TAF in the social health insurance package, with a focus on price negotiation. Future updates are needed as new evidence on the effectiveness and costs of treating chronic hepatitis B emerges.