Published in the May 17 Annals of Internal Medicine, the study may help physicians worldwide in making treatment decisions. Researchers note that a degree of uncertainly exists on how to best initiate hepatitis B treatment due to a constant influx of newer, more expensive drugs that all have varying risks and benefits.

"We need to develop a more calculated approach and establish guidelines for the most cost-effective treatment," said Dr. Fasiha Kanwal, first author and research fellow, Division of Digestive Diseases, David Geffen School of Medicine at UCLA and Veterans Affairs Greater Los Angeles Healthcare System.

Researchers performed an economic analysis comparing the cost-effectiveness of five competing drug treatment strategies for chronic hepatitis B: 1) No treatment at all 2) Interferon alone 3) Lamivudine alone 4) Adefovir alone 5) Beginning therapy with lamivudine, but changing to adefovir if viral resistance is encountered.

Investigators found that the newest drug therapy -- adefovir was not cost-effective when taken alone. However, adefovir was very cost-effective when reserved as a second-line agent in people who develop viral resistance for lamivudine a therapy that has been available for over 15 years.

The study notes that interferon the oldest of all available therapies -- may still be preferred in health care systems with limited resources and is especially cost-effective with "e-antigen negative" patients, which is a more serious type of hepatitis B.

"We found that the newer, more 'sexy' drugs are too expensive and better to use only after other first line therapies have failed," said Dr. Brennan M. R. Spiegel, study author and co-di
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Contact: Rachel Champeau
rchampeau@mednet.ucla.edu
310-794-0777
University of California - Los Angeles
16-May-2005