--- title: "Hibsago (bepirovirsen) in Chronic hepatitis B virus infection in adults without cirrhosis: cost-effectiveness analyses and utility weights" description: "Published cost-effectiveness analyses and health-state utility weights for Hibsago (bepirovirsen, GSK3228836) in Chronic hepatitis B virus infection in adults without cirrhosis, each value quoted from the article: 14 cost-effectiveness analyses and 10 studies reporting utility weights. Analyses: Tenofovir disoproxil fumarate, entecavir, tenofovir alafenamide, and pegylated interferon as first-line treatment in chronic hepatitis B, China: Dai et al. (2022); Entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide versus best supportive care in chronic hepatitis B, China: Lin et al. (2025); Tenofovir alafenamide versus entecavir in chronic hepatitis B, Taiwan: Lai et al. (2024); Extended-duration nucleoside analogue and pegylated interferon alfa combination versus nucleoside analogue monotherapy in HBeAg-negative chronic hepatitis B, China: Li et al. (2021); 10 further articles. Utility weights: Utility weights for chronic hepatitis B, HBeAg seroconversion, HBsAg loss, flare, resistance, cirrhosis, hepatocellular carcinoma, and liver transplantation, HBeAg-negative chronic hepatitis B: Veenstra et al. (2008); Utility weights for chronic hepatitis B, HBeAg seroconversion, HBsAg loss, flare, resistance, cirrhosis, hepatocellular carcinoma, liver transplant, and pegylated interferon treatment, HBeAg-positive chronic hepatitis B: Spackman and Veenstra (2008); Utility weights for chronic hepatitis B, virological response, HBsAg clearance, cirrhosis, hepatocellular carcinoma, and liver transplant, HBeAg-negative chronic hepatitis B: Iannazzo et al. (2013); Utility weights for HBsAg loss, chronic hepatitis B, cirrhosis, liver transplantation, and hepatocellular carcinoma, chronic hepatitis B: Li et al. (2021); 6 further articles. Every value is a verbatim quote from the primary article it is shown with." canonical: "https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/cost-effectiveness-analyses" published: "2026-10-22T07:49:06-04:00" modified: "2026-10-22T07:49:06-04:00" --- # Hibsago (bepirovirsen) in Chronic hepatitis B virus infection in adults without cirrhosis: cost-effectiveness analyses and utility weights Published cost-effectiveness analyses and health-state utility weights that a model of this product could cite, adapt, or compare against, grouped by how each article relates to the product and its indication. Every value is quoted from the article it cites, and section 3 lists the searches that found the articles. ## Overview | Item | Detail | | --- | --- | | Literature searched | Tufts Medical Center Cost-Effectiveness Analysis Registry, searched October 21, 2026; the queries are listed in section 3. | | Cost-effectiveness analyses | 14 | | Studies reporting utility weights | 10 | ## 1 Cost-effectiveness analyses ### 1.1 Analyses of Hibsago (bepirovirsen and GSK3228836) No evidence found. ### 1.2 Treatments for the same indication #### Tenofovir disoproxil fumarate, entecavir, tenofovir alafenamide, and pegylated interferon as first-line treatment in chronic hepatitis B, China: Dai et al. (2022) Relevance: Evaluates first-line tenofovir disoproxil fumarate, entecavir, tenofovir alafenamide, and pegylated interferon in chronic hepatitis B in China, covering the nucleos(t)ide analogues and the pegylated interferon alfa listed in section 2 as current treatment options. Access: Free full text > “A Markov model describing CHB disease progression was constructed to compare the cost-effectiveness of the first-line therapies, considering both satisfactory (HBeAg seroconversion) and optimal (HBsAg seroclearance) treatment goals.” > “We simulated disease progression of 1000 hypothetical 30-year-old Chinese patients with CHB at baseline over 45 years, considering an average life expectancy of 76 years in China” > “We considered four therapies (Peg-IFN, TAF, TDF and ETV) compared with a baseline strategy of no treatment.” > “Societal perspective was adopted for the cost-effectiveness analysis considering both direct and indirect costs” > “The incremental cost-effectiveness ratio (ICER) was used for comparing different strategies, at an annual discount rate of 3%” > “Peg-IFN had the lowest ICER for HBeAg+ patients achieving satisfactory and optimal goals, at $3691 (range for different HBV DNA levels $2734–4824) and $1650 (range $1265–2025) per additional QALY gained respectively (Table 2).” > “However, Peg-IFN was dominated by nucleotide analogues in treating HBeAg– patients to achieve a virological response.” > “The ICER for TAF compared to TDF was $10 710 (range $9511–12 230) per additional QALY gained, which was cost-effective in the Eastern region for HBeAg+ patients achieving an optimal goal (Table 2).” > “ETV was dominated by TDF and TAF among first-line treatments” > “The comparator for each ICER is the previous least costly strategy.” Source: [Dai et al. (2022)](https://doi.org/10.1016/j.cmi.2021.06.024) | Goal | Population | Strategy | Incremental costs (US$) | Incremental QALYs | ICER (range), US$ | | --- | --- | --- | --- | --- | --- | | “Achieving satisfactory goal” | “Immunoactive CHB, HBeAg+” | “TDF” | “6102” | “1.12” | “5431 (3300–7534)” | | “Achieving satisfactory goal” | “Immunoactive CHB, HBeAg+” | “ETV” | “3979” | “0.12” | “Dominated” | | “Achieving satisfactory goal” | “Immunoactive CHB, HBeAg+” | “TAF” | “9092” | “0.54” | “16 909 (14 268–20 451)” | | “Achieving satisfactory goal” | “Immunoactive CHB, HBeAg+” | “Peg-IFN” | “11 761” | “3.19” | “3691 (2734–4824)” | | “Achieving satisfactory goal” | “Immunoactive CHB, HBeAg-” | “TDF” | “5372” | “3.79” | “1418 (785–2692)” | | “Achieving satisfactory goal” | “Immunoactive CHB, HBeAg-” | “ETV” | “4616” | “0.10” | “Dominated” | | “Achieving satisfactory goal” | “Immunoactive CHB, HBeAg-” | “TAF” | “8272” | “1.73” | “4779 (4407–6275)” | | “Achieving satisfactory goal” | “Immunoactive CHB, HBeAg-” | “Peg-IFN” | “14 216” | “3.65” | “Dominated” | | “Achieving optimal goal (HBsAg seroclearance)” | “Immunoactive CHB, HBeAg+” | “TDF” | “10 411” | “4.51” | “2307 (1659–2903)” | | “Achieving optimal goal (HBsAg seroclearance)” | “Immunoactive CHB, HBeAg+” | “ETV” | “17 508” | “3.98” | “Dominated” | | “Achieving optimal goal (HBsAg seroclearance)” | “Immunoactive CHB, HBeAg+” | “TAF” | “15 251” | “1.42” | “10 710 (9511–12 230)” | | “Achieving optimal goal (HBsAg seroclearance)” | “Immunoactive CHB, HBeAg+” | “Peg-IFN” | “10 431” | “6.32” | “1650 (1265–2025)” | Source: [Dai et al. (2022)](https://doi.org/10.1016/j.cmi.2021.06.024) #### Entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide versus best supportive care in chronic hepatitis B, China: Lin et al. (2025) Relevance: Evaluates entecavir, tenofovir disoproxil fumarate, and tenofovir alafenamide against best supportive care in chronic hepatitis B in China, the nucleos(t)ide analogue therapy that continued as background treatment in both arms of the B-Well 1 and B-Well 2 trials. > “A cost-utility analysis was performed, considering direct medicine costs and health utility background.” > “A Markov model simulated a hypothetical cohort of 100,000 Chinese CHB patients aged 14 years, meeting Chinese guideline criteria for hepatitis B treatment” > “The model spanned a lifetime horizon of 64 years, aligning with the Chinese life expectancy of 78 years” > “All costs were converted from Chinese Yuan (CNY) to US dollars (USD) at an average exchange rate of 7.3:1 (CNY: USD) in 2023. Both costs and QALYs were discounted annually at a rate of 5%, following China’s Guidelines for Pharmacoeconomic Evaluations” > “In comparison to Non-NAs BSC, TAF yielded an additional 2.68 QALYs per person, with an ICER of 7,853.22 USD/QALY. Subsequently, TDF generated an additional 2.61 QALYs/person at an ICER of 7,153.39 USD/QALY, and ETV produced an additional 2.01 QALYs/person with an ICER of 9,366.74 USD/QALY without NVBP.” > “Incorporating NVBP, the ICERs for TAF, TDF, and ETV decreased to −745.62 USD/QALY, −729.33 USD/QALY, and −871.11 USD/QALY, respectively, compared to non-NAs BSC.” > “At willingness-to-pay (WTP) thresholds ranging from 12,500 USD/QALY to 37,500 USD/QALY, TAF with NVBP showed an increased probability (51.15–52.47%) of being the optimal treatment strategy, followed by TDF and ETV with NVBP exhibiting a reduced likelihood 43.09–42.45% and 6.40–4.48% in the iterations.” Source: [Lin et al. (2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12250602/) #### Tenofovir alafenamide versus entecavir in chronic hepatitis B, Taiwan: Lai et al. (2024) Relevance: Compares tenofovir alafenamide with entecavir in chronic hepatitis B in Taiwan from a payer perspective, nucleos(t)ide analogues that make up the background therapy of the bepirovirsen label population. > “We performed inverse probability of treatment weighting (IPTW) to match the independent variables between the two treatment groups. The incremental cost effectiveness ratio (ICER) of the two treatment groups was simulated using a decision tree with the Markov annual-cycle model.” > “A total of 54 patients treated with TAF and 98 with ETV from January 2016 to December 2020 were enrolled.” > “This was a payer’s perspective pharmacoeconomic study, and data involving the direct medical cost were retrieved from the health insurance claims of the National Health Insurance Research Database (NHIRD).” > “According to local clinical experience, we set one cycle at one year and the research time horizon at 30 years.” > “Each cost structure was adjusted to the present value in 2021 according to Taiwan’s consumer price index (CPI), and the cost and quality-adjusted life years (QALYs) in the decision-making model were discounted at a rate of 2%.” > “Within this temporal framework, the total costs for individuals within the TAF group were registered at NT$1,241,822, corresponding to an effectiveness of 14.63 QALYs. In contrast, the ETV group incurred total costs of NT$1,317,920, accompanied by an effectiveness of 11.44 QALYs (Table 3).” > “When the time horizon was set at 30 years, the ICER of the TAF group compared with the ETV group was −NT$23,878 per QALY, suggesting more cost savings for TAF.” > “Additionally, the CUAC revealed that when the WTP was between NT$0 and NT$990,120, the probability for the TAF group being more cost effective than the ETV group was 100% (Figure 5).” Source: [Lai et al. (2024)](https://pmc.ncbi.nlm.nih.gov/articles/PMC10887268/) #### Extended-duration nucleoside analogue and pegylated interferon alfa combination versus nucleoside analogue monotherapy in HBeAg-negative chronic hepatitis B, China: Li et al. (2021) Relevance: Evaluates extended-duration combination antiviral treatment against nucleos(t)ide analogue monotherapy in HBeAg-negative chronic hepatitis B in China, an add-on strategy to background nucleos(t)ide analogue therapy whose model includes an HBsAg health state. > “Drawing on experience in China, we used a Markov model to simulate disease progression among a population of hepatitis B e antigen-negative chronic hepatitis B patients with surface antigen levels of ≤1,000 IU/mL through a discrete series of health states.” > “The model’s time horizon was 50 years, with a cycle length of 1 year, and patients from the initial state could either move to another state or remain in the same state after a 1-year cycle. A half-cycle correction was applied.” > “All costs were converted to 2018 values in USDs using an exchange rate of 1 USD =6.6174 Chinese Yuan. The discount rate was determined to be 5% per annum” > “The combination therapy produced 15.8 quality-adjusted life-years, and cost US dollars (USD) 45,032 per patient. The monotherapy gave 13.9 quality-adjusted life-years, and had a cost of USD 52,064. The incremental cost-effectiveness ratio of the monotherapy (USD −3,755 per quality-adjusted life-year) did not obtain extended dominance over combination therapy.” > “The most cost-effective option was combination therapy among patients with hepatitis B surface antigen levels of ≤10 IU/mL, which had the lowest calculated cost of USD 35,318 and most quality-adjusted life-years (16.7).” > “Below the WTP threshold of USD 29,250 (RMB 193,562, three times the domestic GDP per capita in 2018) per QALY, the combination treatment became more cost-effective compared with NA monotherapy as WTP increased” Source: [Li et al. (2021)](https://pmc.ncbi.nlm.nih.gov/articles/PMC8506536/) #### First-line pegylated interferon alfa-2a with a week-12 stopping rule followed by tenofovir disoproxil fumarate or entecavir versus nucleos(t)ide analogue alone in HBeAg-negative chronic hepatitis B, Italy: Iannazzo et al. (2013) Relevance: Evaluates first-line pegylated interferon alfa-2a with an early HBV DNA and HBsAg stopping rule, followed by a switch to entecavir or tenofovir disoproxil fumarate, against nucleos(t)ide analogue treatment alone in HBeAg-negative chronic hepatitis B in Italy, a finite interferon course in a model with an HBsAg clearance state. Access: Free full text Not quoted: The perspective, discount rate, and the ratio for each comparison are reported in the full text, which the publisher provides as a PDF that this page does not quote. > “We assessed the cost-effectiveness of week-12 HBV DNA/HBsAg stopping rule for early interruption and switch to currently most effective NA treatments (entecavir [ETV] or tenofovir disoproxil fumarate [TDF]).” > “A decision-analytic Markov model was developed in the following health-related states: CHB, compensated cirrhosis (CC) and decompensated cirrhosis, hepatocellular carcinoma, liver transplant, post-liver transplant, death, virological response, relapse and HBsAg clearance.” > “Simulated strategies included: ETV/TDF in CHB; ETV/TDF delayed until CC; first-line PEG-IFN followed by switch to ETV/TDF for either patients meeting the week-12 stopping rule or week-48 null-responders/relapsers; and first-line PEG-IFN followed by switch to ETV/TDF delayed until CC.” > “A lifetime simulation horizon was applied.” > “Early treatment strategies using NAs with or without first-line PEG-IFN provided the highest results (approximately 22 life-years and 15 quality-adjusted life years [QALYs]).” > “The average per-patient lifetime costs ranged from €33,500 (TDF in CC) to €68,900 (TDF in CHB). Costs using ETV were 20-50% higher. First-line PEG-IFN strategies ranged from dominant (that is, more effective and less costly) to highly cost-effective, although differences in QALYs were always very narrow.” Source: [Iannazzo et al. (2013)](https://pubmed.ncbi.nlm.nih.gov/23486701/) #### Antiviral treatment sequences of pegylated interferon alfa-2a, tenofovir disoproxil fumarate, entecavir, and lamivudine versus no treatment in HBeAg-positive and HBeAg-negative chronic hepatitis B, United Kingdom: Bermingham et al. (2015) Relevance: Evaluates sequences of pegylated interferon alfa-2a, entecavir, tenofovir, and lamivudine in HBeAg-positive and HBeAg-negative chronic hepatitis B in the United Kingdom, covering the nucleos(t)ide analogues and the pegylated interferon alfa listed in section 2 as current treatment options. Access: Free full text > “We developed a probabilistic Markov model to compare the cost-effectiveness of all clinically relevant antiviral treatment sequences for nucleos(t)ide-naive adults with hepatitis B e-antigen (HBeAg)-positive or HBeAg-negative CHB.” > “We developed a probabilistic Markov cohort model using TreeAge 2009 to estimate lifetime costs in 2011 British pounds and quality-adjusted life-years (QALYs) from a UK National Health Service (NHS) and personal social services perspective. Costs and QALYs were discounted at the standard annual rate of 3.5%” > “In the base-case analysis, pegylated interferon alpha-2a (peg-IFN α-2a) followed by tenofovir disoproxil fumarate was most effective and cost-effective in HBeAg-positive patients, with a cost of £7488 per QALY gained compared with no treatment.” > “In HBeAg-negative patients, peg-IFN α-2a followed by entecavir was most effective and cost-effective, with a cost of £6981 per QALY gained.” > “In those who fail to achieve HBeAg seroconversion or viral suppression, peg-IFN α-2a → TDF → TDF + LAM is the most effective sequence for people with HBeAg-positive CHB, with a cost of £7488 per QALY gained compared with no treatment. In those with HBeAg-negative CHB, peg-IFN α-2a → ETV → TDF is the most effective sequence, with a cost of £6981 per QALY gained compared with no treatment.” > “Peg-IFN α-2a + LAM → ETV → TDF 60,848 13.60 £4577” > “Under this framework, we see that there is a high degree of uncertainty as to whether peg-IFN α-2a should be administered alone or in combination with LAM and whether ETV or TDF represents the most cost-effective second-line antiviral therapy.” > “At a cost of less than £10,000 per QALY gained, these sequences are considered cost-effective in England and Wales.” Source: [Bermingham et al. (2015)](https://doi.org/10.1016/j.jval.2015.05.007) #### Tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir treatment sequences in HBeAg-positive and HBeAg-negative chronic hepatitis B, Canada: Tian et al. (2020) Relevance: Evaluates tenofovir alafenamide, tenofovir disoproxil fumarate, and entecavir strategies in chronic hepatitis B in Canada, covering the nucleos(t)ide analogues listed in section 2 as current treatment options. Access: Not open access Not quoted: The discount rate and the results for the other treatment sequences are reported in the full text, which this page does not quote. > “We evaluated the cost effectiveness of TAF and other available treatment options for hepatitis B envelope antigen (HBeAg)-positive and HBeAg-negative CHB patients from a Canadian provincial Ministry of Health perspective.” > “A state-transition model based on the published literature was developed to compare treatment strategies involving entecavir (ETV), tenofovir disoproxil fumarate (TDF), and TAF. It adopted a lifetime time horizon.” > “For HBeAg-positive patients, TAF followed by ETV generated an additional 0.16 QALYs/person at an additional cost of Can$14,836.18 with an ICER of Can$94,142.71/QALY compared with TDF followed by ETV. Of the iterations, 28.7% showed that it is the optimal strategy with a Can$50,000 willingness-to-pay threshold.” > “For HBeAg-negative patients, ETV followed by TAF would prevent an additional 13 liver-related deaths per 1000 CHB patients compared with TDF, followed by ETV. It generated an additional 0.13 QALYs/person at an additional cost of Can$59,776.53 with an ICER of Can$461,162.21/QALY compared with TDF, followed by ETV.” > “Our analysis suggests that TAF is not cost effective at its current cost. A 33.4% reduction in price would be required to make it cost effective for HBeAg-positive patients with a Can$50,000 willingness-to-pay threshold.” Source: [Tian et al. (2020)](https://pubmed.ncbi.nlm.nih.gov/31691902/) #### Response-guided peginterferon with a 12-week stopping rule, 48-week peginterferon, entecavir, tenofovir, and telbivudine versus no treatment in chronic hepatitis B, Hong Kong: Lo et al. (2015) Relevance: Compares response-guided pegylated interferon with an early stopping rule and a conventional pegylated interferon course with entecavir, tenofovir, and telbivudine in chronic hepatitis B in Hong Kong, setting a finite treatment course against continuous nucleos(t)ide analogue therapy. Access: Free full text > “We used Markov modeling, with data from the Hong Kong population, to compare the cost effectiveness of peginterferon therapy with a 12-week stopping rule vs conventional therapy (48 weeks) and with other antiviral agents.” > “The analysis was based on societal perspectives, and simulation was performed based on full life cycle of test cohort using a time horizon starting from the year 2012.” > “An annual discount of 3% without inflation adjustment was adopted for both costs and effectiveness as recommended by health economic analyses” > “For HBeAg-positive patients, stopping peginterferon therapy after 12 weeks had the lowest cost-effectiveness ratio (CER), of $9501/quality-adjusted life-year (QALY), compared with no treatment, making it the most cost-effective option. Conventional (48-week) peginterferon treatment had a CER of $9664/QALY.” > “The CERs of oral nucleos(t)ide analogs (NUCs) compared with no treatment were $10,621/QALY in entecavir monotherapy, $13,779/QALY in tenofovir monotherapy, $11,878/QALY in telbivudine monotherapy, and $13,201/QALY in telbivudine with a roadmap approach. Peginterferon with the 12-week stopping rule dominated all of these strategies in the HBeAg-positive model.” > “For HBeAg-negative patients, entecavir had the lowest CER ($34,310/QALY). Entecavir was more cost effective than either peginterferon strategies (CERs of $37,423/QALY for 12 weeks of peginterferon and $38,474/QALY for 48 weeks of treatment).” > “With reference to no treatment, each of the other strategies was cost effective with a CER of $39,750/QALY for tenofovir, $37,423/QALY for peginterferon with a 12-week stopping rule, $38,474/QALY in conventional 48-week peginterferon treatment, $38,330/QALY in telbivudine monotherapy, and $40,081/QALY in telbivudine with a roadmap approach.” Source: [Lo et al. (2015)](https://doi.org/10.1016/j.cgh.2014.06.022) #### Entecavir, lamivudine, and adefovir by treatment duration in HBeAg-negative chronic hepatitis B, United States: Veenstra et al. (2008) Relevance: Evaluates the choice of nucleos(t)ide analogue and the duration of treatment, including fixed courses and on-off schedules, in HBeAg-negative chronic hepatitis B in the United States, bearing on the nucleos(t)ide analogue withdrawal described in section 2. Access: Not open access Not quoted: The discount rate and the results for the other comparisons of drugs and durations are reported in the full text, which this page does not quote. > “We conducted a cost-utility analysis from a payer perspective over a lifetime time horizon.” > “Disease progression probabilities, costs and quality of life data were derived from the literature.” > “We evaluated 5-year, 10-year, lifetime and 5 on-1 off treatment durations. For each of these treatment durations, we evaluated initial therapy with entecavir, lamivudine or adefovir, with addition of adefovir or entecavir for patients who developed virological breakthrough because of resistance (12 strategies total).” > “Increasing treatment duration improved quality-adjusted life-years (QALYs) and was generally cost-effective for all three drugs. However, a 5 on-1 off strategy was the most cost-effective: lifetime vs. 5 on-1 off entecavir had an ICER of $148,200/QALY.” > “In probabilistic sensitivity analyses, entecavir 5 on-1 off was the preferred strategy over the range of commonly reimbursed cost-effectiveness thresholds.” > “Lifetime treatment was preferred to a 5 on-1 off strategy, if treatment durability was < 10%.” Source: [Veenstra et al. (2008)](https://pubmed.ncbi.nlm.nih.gov/18373637/) #### Initial entecavir, pegylated interferon, telbivudine, lamivudine, or adefovir with follow-up therapy versus no treatment in HBeAg-positive chronic hepatitis B, United States: Spackman and Veenstra (2008) Relevance: Evaluates initial entecavir, lamivudine, telbivudine, adefovir, and pegylated interferon strategies with follow-up therapy in HBeAg-positive chronic hepatitis B in the United States, a model whose health states include HBsAg loss and hepatic flare. Access: Not open access Not quoted: The incremental cost-effectiveness ratios for each comparison are reported in the full text, which is closed access. > “We conducted a cost-utility analysis from a US payer perspective over a lifetime time horizon using a Markov model, in a hypothetical population with HBeAg-positive CHB and a mean age of 35 years.” > “We assumed a treatment duration of 4 years, with the use of combination therapy for drug resistance. Nonresponders to pegylated interferon were assumed to receive entecavir in years 3-4.” > “All costs were valued in $US, year 2008 values. Costs and outcomes were discounted at 3% per annum.” > “Initiation with entecavir (18.70 QALYs) and pegylated interferon (18.64 QALYs) provided the largest treatment benefits overall, followed by telbivudine (18.55 QALYs).” > “The probabilities of the interventions being cost effective at a threshold of USD 50,000 per QALY were 57%, 37% and 2% for initiation with entecavir, pegylated interferon and telbivudine, respectively.” Source: [Spackman and Veenstra (2008)](https://pubmed.ncbi.nlm.nih.gov/18850763/) ### 1.3 The same disease in other populations or settings #### Increased monitoring and treatment versus current practice in inactive or immune-tolerant chronic hepatitis B, United States: Toy et al. (2025) Relevance: Evaluates increased monitoring and treatment, and the addition of liver cancer surveillance, among adults with inactive or immune-tolerant chronic hepatitis B without cirrhosis in the United States from a health care system perspective, in a model with HBsAg seroclearance and viral suppression health states. > “A Markov model was used to calculate the costs, health impact and cost-effectiveness of increased monitoring of adults with HBeAg negative inactive or HBeAg positive immune tolerant CHB who have no cirrhosis or significant fibrosis and are not recommended by the current American Association for the Study of Liver Diseases (AASLD) clinical practice guidelines to receive antiviral treatment, and to assess whether the addition of HCC surveillance would be cost-effective.” > “Disease progression between health states, conditional on treatment, age (where available) and sex was simulated in one-year cycles.” > “All costs and QALYs were discounted at a rate of 3% per year. The analysis was performed from the health care system perspective.” > “Compared to current practice, where an estimated 37% of persons with inactive or immune tolerant CHB are monitored and 59% receiving antiviral therapy when they become treatment eligible, increased monitoring to 90% and treatment to 80%” > “Regular monitoring of persons with inactive or immune tolerant CHB who are initially not recommended to receive antiviral treatment in the United States is cost-saving.” > “For every 100,000 persons with inactive or immune active CHB, increasing monitoring to 90% and antiviral treatment for eligible individuals to 80% would save $180 million in lifetime health care costs, add 45,100 QALYs and would avert 4,590 cases of cirrhosis, 1,500 cases of decompensated cirrhosis, 2,450 cases of HCC, and 4,700 HBV related deaths.” > “At a willingness to pay threshold of $100,000/QALY, the addition of HCC surveillance with the standard recommended biannual liver ultrasound and alfa fetoprotein levels is likely cost-effective if the HCC risk ≥ 0.55%/year.” Source: [Toy et al. (2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11753660/) #### One-time universal hepatitis B screening with monitoring and treatment versus current practice in adults, United States: Toy et al. (2022) Relevance: Evaluates one-time universal hepatitis B surface antigen screening of adults, followed by monitoring and treatment, against current practice in the United States, a model of progression of chronic hepatitis B to cirrhosis and hepatocellular carcinoma. Access: Free full text > “We used a Markov model to calculate the costs, population health impact, and cost-effectiveness of 1-time universal screening and CHB monitoring and treatment compared with current practice.” > “We computed results for a hypothetical population of 100 000 men and women aged 18–69 years to potentially be screened. We ran a lifetime analysis.” > “All costs and QALYs were discounted at a rate of 3% per year. The analysis was performed from the healthcare system perspective.” > “Sensitivity analysis was performed on model parameters to identify thresholds for cost-saving or cost-effectiveness based on a willingness to pay of $50 000/quality-adjusted life-year.” > “The analysis assumed testing would be performed during routine healthcare visits and that generic tenofovir or entecavir would be dispensed for treatment. Testing costs were based on Medicare reimbursement rates.” > “At an estimated 0.24% prevalence of undiagnosed CHB, universal hepatitis B surface antigen (HBsAg) screening in adults aged 18–69 years is cost-saving compared with current practice if antiviral treatment drug costs remain below $894/year.” > “Compared with current practice, universal screening would avert an additional 7.4 cases of compensated cirrhosis, 3.3 cases of decompensated cirrhosis, 5.5 cases of hepatocellular carcinoma, 1.9 liver transplants, and 10.3 hepatitis B virus–related deaths at a saving of $263 000/100 000 adults screened.” Source: [Toy et al. (2022)](https://doi.org/10.1093/cid/ciab405) #### Biannual or annual hepatocellular carcinoma surveillance versus no surveillance in chronic hepatitis B with virological remission, China: Fang et al. (2024) Relevance: Evaluates hepatocellular carcinoma surveillance schedules in chronic hepatitis B with virological remission in China, the virally suppressed state on nucleos(t)ide analogue therapy that the bepirovirsen label requires; the ratios shown are those for the advanced fibrosis group. > “We developed an individual-based state transition model, simulating the advancement of HCC in CHB patients with virological remission. We used this model to compare the incremental cost-effectiveness ratio (ICER) and long-term health outcomes of biannual or annual HCC surveillance for varying durations with no surveillance.” > “The baseline population consisted of a cohort of 100,000 CHB patients aged 40 to 70 years (with a greater risk of developing HCC)” > “By altering the duration of surveillance in increments of 5 years from 10 years to lifetime, we simulated various HCC surveillance strategies.” > “The costs were converted to US dollars using the exchange rates applicable in 2021.” > “We applied a 3% yearly discount rate to all future costs and QALYs” > “The study revealed that conducting biannual surveillance for advanced fibrosis in individuals aged 40 had the most favorable incremental cost-effectiveness ratio (ICER) when discontinuing surveillance at the age of 65. This approach was associated with an ICER of USD 4,760/QALY gained. Conversely, the highest ICER was identified when surveillance was discontinued at 50 years of age, leading to a cost of USD 18,900 per QALY gained. Surveillance up to age 75 (USD 12,970/QALY gained) provided most QALY gains of 0.67 at an additional cost of USD 6,446 and was the most cost-effective strategy, with an ICER below the WTP threshold.” > “In the case of 40-year-old patients with advanced fibrosis, the ICER of annual surveillance was found to be the lowest when the surveillance was discontinued at the age of 60, with an ICER of USD 2,759 per QALY gained, and was highest when the stopping age was 55 (USD 34,363/QALY gained), which was not cost-effective with the ICERs exceeding the WTP threshold (USD 32,268/QALY gained).” > “For patients with advanced fibrosis, compared with no surveillance, biannual (Fig. 2C) and annual (Fig. 2D) surveillance for any age group were nondominated. Surveillance targeting those aged 40–75 was the most cost-effective strategy, either biannual (USD 12,970/QALY gained) or annual (USD 4,984/QALY gained) surveillance intervals.” Source: [Fang et al. (2024)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11323655/) #### Nucleos(t)ide analogue therapy versus no treatment in untreated minimally active chronic hepatitis B, South Korea: Lee et al. (2021) Relevance: Evaluates nucleos(t)ide analogue therapy against no treatment in untreated minimally active chronic hepatitis B in South Korea from a health care system perspective, in a model that includes disutilities for kidney and bone adverse events of nucleos(t)ide analogues. > “We compared cost and effectiveness (quality-adjusted life years, QALYs) in virtual UMA-CHB cohorts of 10,000 50-year-olds receiving AVT (scenario 1) vs no treatment (scenario 2) for 10 years. A Markov model, including 7 health states of CHB-related disease progression, was used.” > “An analytic period of 10 years was used in the base-case analysis, which was conducted from the perspective of the health care system. A 5% discount rate was used for the analysis.” > “From the health care system perspective, all estimated costs for each health state included direct and indirect costs such as transportation and caregiving.” > “The total cost per patient over the 10-year horizon was estimated at $15,349 for the NUC therapy group (scenario 1) and $13,148 for the no treatment group, yielding a difference of $2,201.” > “The simulation of AVT vs no treatment predicted $2,201 incremental costs and 0.175 incremental QALYs per patient for 10 years, with an incremental cost-effectiveness ratio (ICER) of $12,607/QALY, suggesting cost-effectiveness of AVT.” > “When the simulated analysis period was extended to 20 years, AVT was also highly cost-effective with an ICER of $2,036/QALY.” > “According to probabilistic sensitivity analysis with the threshold of willingness to pay, the probability of AVT cost-effectiveness was 83.3%.” Source: [Lee et al. (2021)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7889372/) ### 1.4 Related diseases and analogous treatments No evidence found. ## 2 Utility weights ### 2.1 Utility weights from analyses of Hibsago (bepirovirsen and GSK3228836) No evidence found. ### 2.2 Utility weights for the same indication #### Utility weights for chronic hepatitis B, HBeAg seroconversion, HBsAg loss, flare, resistance, cirrhosis, hepatocellular carcinoma, and liver transplantation, HBeAg-negative chronic hepatitis B: Veenstra et al. (2008) Relevance: Utilities for chronic hepatitis B, HBeAg seroconversion, HBsAg loss, hepatic flare, drug resistance, cirrhosis states, hepatocellular carcinoma, and liver transplantation from a U.S. analysis of nucleos(t)ide analogue treatment duration. Access: Not open access Not quoted: The utility weights are reported in the full text, which this page does not quote. > “Disease progression probabilities, costs and quality of life data were derived from the literature.” Source: [Veenstra et al. (2008)](https://pubmed.ncbi.nlm.nih.gov/18373637/) #### Utility weights for chronic hepatitis B, HBeAg seroconversion, HBsAg loss, flare, resistance, cirrhosis, hepatocellular carcinoma, liver transplant, and pegylated interferon treatment, HBeAg-positive chronic hepatitis B: Spackman and Veenstra (2008) Relevance: Utilities for chronic hepatitis B, HBeAg seroconversion, HBsAg loss, flare, treatment resistance, cirrhosis states, hepatocellular carcinoma, and liver transplantation, and a disutility during pegylated interferon treatment, from a U.S. analysis. Access: Not open access Not quoted: The utility weights are reported in the full text, which is closed access. > “Disease progression probabilities, costs and quality-of-life data were derived from the literature.” Source: [Spackman and Veenstra (2008)](https://pubmed.ncbi.nlm.nih.gov/18850763/) #### Utility weights for chronic hepatitis B, virological response, HBsAg clearance, cirrhosis, hepatocellular carcinoma, and liver transplant, HBeAg-negative chronic hepatitis B: Iannazzo et al. (2013) Relevance: Utilities for chronic hepatitis B, virological response, HBsAg clearance, compensated and decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation in HBeAg-negative chronic hepatitis B. Access: Free full text Not quoted: The utility weights are reported in the full text, which the publisher provides as a PDF that this page does not quote. > “A decision-analytic Markov model was developed in the following health-related states: CHB, compensated cirrhosis (CC) and decompensated cirrhosis, hepatocellular carcinoma, liver transplant, post-liver transplant, death, virological response, relapse and HBsAg clearance.” Source: [Iannazzo et al. (2013)](https://pubmed.ncbi.nlm.nih.gov/23486701/) #### Utility weights for HBsAg loss, chronic hepatitis B, cirrhosis, liver transplantation, and hepatocellular carcinoma, chronic hepatitis B: Li et al. (2021) Relevance: Utilities for an HBsAg state, chronic hepatitis B, compensated and decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation in HBeAg-negative chronic hepatitis B treated with nucleos(t)ide analogues. | Health state | Utility | | --- | --- | | “HBsAg loss” | “0.95 (0.90, 0.99)” | | “Chronic hepatitis B” | “0.95 (0.90, 0.99)” | | “Compensated cirrhosis” | “0.69 (0.66, 0.71)” | | “Decompensated cirrhosis” | “0.35 (0.32, 0.37)” | | “Liver transplantation” | “0.41 (0.37, 0.45)” | | “Post liver transplantation” | “0.55 (0.49, 0.61)” | | “Hepatocellular carcinoma” | “0.38 (0.36, 0.41)” | Source: [Li et al. (2021)](https://pmc.ncbi.nlm.nih.gov/articles/PMC8506536/) #### Utility weights for chronic hepatitis B, decompensated cirrhosis, hepatocellular carcinoma, post-transplant, hepatic flare, and peginterferon treatment, chronic hepatitis B: Lo et al. (2015) Relevance: Utilities for chronic hepatitis B, decompensated cirrhosis, hepatocellular carcinoma, post-transplant, hepatic flare, and pegylated interferon treatment, including the hepatic flare state that the bepirovirsen boxed warning names. Access: Free full text > “Utility estimates of various health states were derived from the best available published data in Asia and Hong Kong.” Source: [Lo et al. (2015)](https://doi.org/10.1016/j.cgh.2014.06.022) | Health state | Utility | | --- | --- | | “CHB” | “0.99” | | “Decompensated cirrhosis” | “0.70” | | “HCC” | “0.72” | | “Post-transplant” | “0.78” | | “Hepatic flare-up” | “0.3” | | “Pegylated interferon use” | “0.7” | Source: [Lo et al. (2015)](https://doi.org/10.1016/j.cgh.2014.06.022) #### Utility weights for HBsAg seroconversion, active chronic hepatitis B, viral suppression, cirrhosis, hepatocellular carcinoma, and liver transplant, chronic hepatitis B: Bermingham et al. (2015) Relevance: Utilities for HBsAg seroconversion, active chronic hepatitis B, viral suppression, cirrhosis states, hepatocellular carcinoma, and liver transplantation from the United Kingdom analysis of antiviral sequences. Access: Free full text > “More recently, Woo et al. [34] elicited utilities from 400 Canadians with CHB using the standard gamble technique to elicit values for six CHB-related health states” Source: [Bermingham et al. (2015)](https://doi.org/10.1016/j.jval.2015.05.007) | Health state | Utility | | --- | --- | | “HBsAg seroconversion” | “0.87” | | “Active noncirrhotic CHB” | “0.87” | | “Viral suppression” | “0.87” | | “Compensated cirrhosis” | “0.81” | | “Decompensated cirrhosis” | “0.49” | | “Hepatocellular carcinoma” | “0.85” | | “Postliver transplant” | “0.72” | Source: [Bermingham et al. (2015)](https://doi.org/10.1016/j.jval.2015.05.007) #### Utility weights for chronic hepatitis B, cirrhosis, hepatocellular carcinoma, and post-liver transplant, chronic hepatitis B: Lin et al. (2025) Relevance: EQ-5D utilities for chronic hepatitis B, compensated and decompensated cirrhosis, hepatocellular carcinoma, and post-liver transplant in an analysis of nucleos(t)ide analogues in China. | Health state | Utility | | --- | --- | | “CHB (EQ-5D)” | “0.99” | | “CC (EQ-5D)” | “0.80” | | “DC (EQ-5D)” | “0.60” | | “HCC (EQ-5D)” | “0.73” | | “Post-liver transplant (EQ-5D)” | “0.84” | Source: [Lin et al. (2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC12250602/) ### 2.3 Utility weights for the same disease in other populations or settings #### Utility weights for chronic hepatitis B by disease state, viral suppression, and HBsAg seroclearance, chronic hepatitis B: Toy et al. (2025) Relevance: Utilities by chronic hepatitis B state, including inactive disease, viral suppression, HBsAg seroclearance, cirrhosis, decompensated cirrhosis, hepatocellular carcinoma by mode of detection, and liver transplantation, used in a United States model. | Health state | Utility | Source of the value | | --- | --- | --- | | “Active CHB” | “0.91 (0.80–0.92)” | “Woo et al. (EQ-5D)” | | “Inactive CHB” | “1.00 (0.90–1.00” | “Assumption” | | “Cirrhosis” | “0.88 (0.78–0.88)” | “Woo et al. (EQ-5D)” | | “Decompensated cirrhosis” | “0.73 (0.49–0.82)” | “Woo et al. (EQ-5D)” | | “Symptom detected HCC” | “0.67 (0.54–0.80)” | “Parikh et al. 2020” | | “Screen detected HCC non-cirrhosis” | “0.81 (0.65–0.85)” | “Woo et al. (EQ-5D)” | | “Screen detected HCC cirrhosis” | “0.70 (0.66–0.84)” | “Parikh et al. 2020” | | “Liver Transplantation” | “0.84 (0.72–0.84)” | “Woo et al. (EQ-5D)” | | “HBsAg seroclearance” | “1.00 (0.95–1.00)” | “Assumption” | | “Viral suppression” | “1.00 (0.95–1.00)” | “Assumption” | Source: [Toy et al. (2025)](https://pmc.ncbi.nlm.nih.gov/articles/PMC11753660/) #### Utility weights for active chronic hepatitis B, cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation, chronic hepatitis B: Toy et al. (2022) Relevance: Utilities for active chronic hepatitis B, cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and liver transplantation, used in a United States model of universal hepatitis B screening. Access: Free full text > “We used EQ5D utility assessments calculated by Woo et al [40] based on a Canadian CHB patient sample and included age adjustments.” Source: [Toy et al. (2022)](https://doi.org/10.1093/cid/ciab405) | Health state | Utility | | --- | --- | | “Active CHB” | “0.91 (0.80–0.92)” | | “Cirrhosis” | “0.88 (0.78–0.88)” | | “Decompensated cirrhosis” | “0.73 (0.49–0.82)” | | “Hepatocellular carcinoma” | “0.81 (0.77–0.85)” | | “Liver transplantation” | “0.84 (0.72–0.84)” | Source: [Toy et al. (2022)](https://doi.org/10.1093/cid/ciab405) #### Utility weights for minimally active chronic hepatitis B, liver disease states, and adverse events of nucleos(t)ide analogue therapy, chronic hepatitis B: Lee et al. (2021) Relevance: Utilities for minimally active chronic hepatitis B, virological response, cirrhosis states, hepatocellular carcinoma, and liver transplantation, with disutilities for chronic kidney disease, osteopenia, and osteoporosis as adverse events of nucleos(t)ide analogue therapy. | Health state | Utility (disutility for CKD, osteopenia, and osteoporosis) | Source of the value | | --- | --- | --- | | “UMA-CHB” | “0.820” | “Ock et al.” | | “CHB-VR” | “0.820” | “Ock et al.” | | “CC” | “0.663” | “Levy et al.” | | “DCC” | “0.391” | “Levy et al.” | | “HCC” | “0.508” | “Kim et al.” | | “LT” | “0.50” | “Aberg et al.” | | “Post-LT” | “0.77” | “Aberg et al.” | | “CKD (stage 3)” | “0.119 (=0.959–0.840)” | “Data from KNHANES” | | “Osteopenia” | “0.053 (=0.959–0.906)” | “Data from KNHANES” | | “Osteoporosis” | “0.109 (=0.959–0.850)” | “Data from KNHANES” | Source: [Lee et al. (2021)](https://pmc.ncbi.nlm.nih.gov/articles/PMC7889372/) ### 2.4 Utility weights for related diseases and analogous treatments No evidence found. ## 3 Search strategy | Dataset | Query | Results | | --- | --- | --- | | Ratios | bepirovirsen OR GSK3228836 | 0 | | Methods | bepirovirsen | 0 | | Methods | "functional cure" AND "hepatitis B" | 1 | | Ratios | "chronic hepatitis B" AND (tenofovir OR entecavir) | 333 | | Methods | "hepatitis B" | 223 | | Methods | HBV | 113 | | Ratios | "HBsAg" OR "functional cure" OR "HBsAg loss" OR "seroclearance" | 131 | | Weights | "hepatitis B" | 1015 | | Weights | "surface antigen" OR "HBsAg" OR "seroclearance" OR "functional cure" | 217 | | Ratios | "hepatitis B" AND (peginterferon OR "pegylated interferon" OR "peg-interferon" OR "PEG-IFN") | 121 | | Ratios | "hepatitis B" AND (discontinuation OR stopping OR "finite" OR withdrawal OR "duration") | 63 | | Ratios | antisense OR inotersen OR eplontersen OR mipomersen OR olezarsen | 4 | | Methods | "hepatitis C" AND ledipasvir AND "United States" | 4 | | Weights | "thrombocytopenia" AND "hepatitis" | 9 | | Weights | "hepatitis B" AND flare | 5 | ## Related pages - [Hibsago (bepirovirsen): Chronic hepatitis B virus infection in adults without cirrhosis](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis) · [Markdown](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis.md) - [Hibsago (bepirovirsen) in Chronic hepatitis B virus infection in adults without cirrhosis: Terms and abbreviations](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/terms-and-abbreviations) · [Markdown](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/terms-and-abbreviations.md) - [Hibsago (bepirovirsen): Chronic hepatitis B virus infection in adults without cirrhosis](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/executive-summary) · [Markdown](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/executive-summary.md) - [Hibsago (bepirovirsen) in Chronic hepatitis B virus infection in adults without cirrhosis: Product information and disease description](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/product-information-and-disease-description) · [Markdown](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/product-information-and-disease-description.md) - [Hibsago (bepirovirsen) in Chronic hepatitis B virus infection in adults without cirrhosis: Clinical evidence](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/clinical-evidence) · [Markdown](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/clinical-evidence.md) - [Hibsago (bepirovirsen) in Chronic hepatitis B virus infection in adults without cirrhosis: Economic information and modeling report](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/economics) · [Markdown](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/economics.md) - [Hibsago (bepirovirsen) in Chronic hepatitis B virus infection in adults without cirrhosis: References](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/references) · [Markdown](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/references.md) - [Hibsago (bepirovirsen) in Chronic hepatitis B virus infection in adults without cirrhosis: new drug review](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/monograph/review) · [Markdown](https://www.evicenter.com/drugs/hibsago--chronic-hepatitis-b-virus-infection-in-adults-without-cirrhosis/monograph/review.md)