Buti M, Casado M A, Fosbrook L, Wong J B, Esteban R
Department of Hepatology, Hospital Vall d'Hebrón, Barcelona, Spain.
J Hepatol. 2000 Oct;33(4):651-8. doi: 10.1034/j.1600-0641.2000.033004651.x.
BACKGROUND/AIMS: The higher initial cost of combination therapy is a factor which may discourage its use in naive patients with histologically mild or moderate chronic hepatitis C. However, chronic hepatitis C is a slowly progressive disease associated with a decrease in life expectancy and quality of life. The objective of this study was to determine if the incremental sustained response rate of combination therapy is sufficient to outweigh its extra cost.
Chronic hepatitis C progression was studied using a Markov model in which cohorts of patients were treated with combination therapy for 6-12 months or with interferon for 12 months. The sustained virological response rates applied were 43, 35 and 19%, respectively, for combination therapy for 12 months, for 6 months and for interferon for 12 months. Costs for each clinical state were calculated according to clinical practice in Spain.
In a 30-year-old patient with moderate chronic hepatitis C, combination therapy for 12 months increases life expectancy by 4.1 years compared with interferon for 12 months. In mild disease, the increase in life expectancy is lower. The cost per life-year saved in patients with chronic hepatitis C ranges from 880 to 64.421 euros depending on the age of the patient, the degree of hepatic lesion and the type and duration of therapy. Compared to other treatments accepted as standard practice in other therapeutic areas, combination therapy for chronic hepatitis C is cost-effective.
In patients of any age with moderate chronic hepatitis C and those with mild disease under 50 years of age, combination therapy for 12 months is the most cost-effective schedule, whereas in older patients with mild hepatitis, combination therapy for 6 months is the preferred option based on cost-effectiveness criteria.
背景/目的：联合治疗较高的初始成本可能会阻碍其在组织学上为轻度或中度慢性丙型肝炎初治患者中的应用。然而，慢性丙型肝炎是一种进展缓慢的疾病，会导致预期寿命和生活质量下降。本研究的目的是确定联合治疗增加的持续应答率是否足以抵消其额外成本。
使用马尔可夫模型研究慢性丙型肝炎的进展，其中患者队列分别接受6 - 12个月的联合治疗或12个月的干扰素治疗。应用的持续病毒学应答率分别为：联合治疗12个月为43%，联合治疗6个月为35%，干扰素治疗12个月为19%。根据西班牙的临床实践计算每种临床状态的成本。
在一名30岁的中度慢性丙型肝炎患者中，与12个月的干扰素治疗相比，12个月的联合治疗可使预期寿命延长4.1年。在轻度疾病中，预期寿命的增加较低。慢性丙型肝炎患者每挽救一年生命的成本在880欧元至64421欧元之间，具体取决于患者年龄、肝脏病变程度以及治疗类型和持续时间。与其他治疗领域被视为标准治疗的其他疗法相比，慢性丙型肝炎的联合治疗具有成本效益。
在任何年龄的中度慢性丙型肝炎患者以及50岁以下的轻度疾病患者中，12个月的联合治疗是最具成本效益的方案，而在老年轻度肝炎患者中，基于成本效益标准，6个月的联合治疗是首选方案。
