Treatment of Chronic Hepatitis B infection using Pegylated Interferon and Emtricitabin + Tenofovir: Preliminary Cost Burden and Policy Implications.

Abstract

Hepatitis B infection remains a major cause of global mortality with Nigeria identified as a country with significant endemicity. Little is however known about the cost burden for managing Hepatitis B infection in this setting, or what policies exist to ensure access to care.

A sample of one hundred patients recruited at National Assembly Medical Centre was screened for Hepatitis B. The study aimed at identifying clinical outcomes and economic burden of treating Hepatitis B with a treatment regimen of Pegylated Interferon alfa-2a (PEG-INFalfa-2a) and Emtricitabine + Tenoforvir (ET). Parameters evaluated include viral load (VL), sero-conversion and liver function test (LFT). Direct and indirect medical costs that were determined include laboratory investigations (HBsAg), VL, LFT, drugs and visits.

The result showed a 7.2% prevalence of HBsAg. Initial monotherapy with PEG-INFalfa-2a resulted in sero-conversion in 5 out of the 8 treated cases (62.5%) with a drop in VL to an undetected value (less than 20 copies/ml).  In the rest (37.5%), VL rose to a range of 12000 - 35000 copies/ml and elevated liver enzyme [Alanine Transaminase (ALT)] increased to a range of 94-197 u/ml. Therapy switch to ET in treatment phase 2 (non-responsive in phase 1) led to a decrease of VL to 2500-3000 copies/ml. Follow up therapy with PEG-INFalfa-2a resulted in further decrease after 96 weeks.  Mono-therapy with PEG-INFalfa-2a cost N2,395,250 ($14,089.91) while PEG-INFalfa-2a + ET was N4,182,333 ($24,601.96).

The treatment of Hepatitis B infection is of significant importance to both individual patients, and the national healthcare system, due to the considerable costs. Considering Hepatitis B infection as a Public Health Emergency will stimulate the relevant policies which can stem the looming epidemic.

Keywords: Hepatitis B; Pegylated-interferon; Outcomes; Costs; Policy