The Committee discussed the ICERs for entecavir in the HBeAg-negative population that had been derived from the original manufacturer's analysis, the ERG's analysis and the revised modelling provided by the manufacturer. Assuming a lifetime treatment duration and continuation of treatment with entecavir when the disease progressed to compensated cirrhosis, the cost-effectiveness estimate was just over £20,000 per QALY gained when all patients start in the pre-cirrhotic state, and £24,335 per QALY gained if 10% of patients are assumed to have cirrhosis at the start of treatment, when compared with lamivudine. The Committee noted the manufacturer's comments that progression to cirrhosis could be linked to the development of viral resistance. Therefore, accepting the lower rate of resistance development with entecavir compared to lamivudine may mean that the rate of progression was also likely to be lower. The Committee therefore agreed that there was uncertainty about the likely rate of progression to cirrhosis when comparing lamivudine to entecavir, and that use of the 1.8% estimate could have resulted in an underestimation of the cost effectiveness of entecavir. However, the Committee noted that there was still uncertainty surrounding the model – namely the lack of evidence on which to assess the plausibility of efficacy estimates of therapies over a lifetime treatment duration, and that the cost effectiveness compared with other available treatments had not been evaluated.