Interventions:
The authors provided a justification for the selection of the comparators. This was that although other drugs were available for the treatment of CHB, only lamivudine and entecavir were considered in the two-year RCT, which was used as the source for the treatment efficacy data.
Effectiveness/benefits:
The authors did not report the method and conduct of a systematic review of the literature, but stated that a critical review was conducted and justified their selection of some studies. The source of treatment efficacy was selected in accordance with the objective of the study and the availability of the two-year RCT. RCTs are usually considered to be valid sources of evidence. The authors reported the estimates available in the literature and discussed their selection. Where data were not available, the estimates were investigated in the sensitivity analysis. All the assumptions made were explicitly reported. Details on the derivation of the benefit measure were reported. The approach used to obtain the utility valuations from the published evidence was reported. QALYs are a validated and appropriate benefit measure, especially for a disease such as CHB which has a substantial impact on the patients’ quality of life.
Costs:
The analysis of costs reflected the authors’ perspective. However, costs were not broken down into individual items, except for drug acquisition costs. Instead, macro-categories were presented. This might reduce the transparency of the economic analysis as it is not clear which costs were included. The costs were derived from previous studies, the details of which were not provided. The price year and the use of discounting were reported. The sensitivity analysis investigated the uncertainty underlying the economic estimates.
Analysis and results:
The synthesis of costs and benefits was appropriately performed using incremental analysis. The issue of uncertainty was satisfactorily addressed in the sensitivity analyses and the alternative scenarios were clearly described. Extensive information on the decision model was given and the model structure was described in detail, with a diagram. The model findings were validated against real-world data. The authors noted some limitations to their analysis particularly around the lack of reliable long-term data on the disease progression. Finally, the authors compared their results with those obtained from other studies highlighting the reasons for differences in the findings.
Concluding remarks:
The study methodology appears to have been robust and valid. The sources and results were generally well reported, with some limitations in the reporting of the economic data. Overall, the authors’ conclusions appear to be valid.