Hoshida Yujin, Shiratori Yasushi, Omata Masao
Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Japan.
Liver. 2002 Dec;22(6):479-85. doi: 10.1034/j.1600-0676.2002.01736.x.
To evaluate cost-effectiveness of adjuvant interferon therapy used with surgical resection of hepatitis C-related primary hepatocellular carcinoma.
We constructed a Markov model that simulated adjuvant interferon therapy after resection of hepatitis C-related hepatocellular carcinoma, and evaluated life expectancy, costs, and cancer recurrence. The reference case is a 60-year-old man with hepatitis C-related compensated cirrhosis.
At the baseline, adjuvant interferon therapy yielded 6.1 life years with a cost of dollars 77000, and an incremental cost-effectiveness ratios of dollars 15700/life year compared with no interferon therapy. The proportion of patients who experienced recurrence of hepatocellular carcinoma until death was reduced from 87.6% to 62.9% using adjuvant interferon therapy. The incidence of recurrent hepatocellular carcinoma after interferon influenced the cost-effectiveness of adjuvant interferon therapy. A threshold analysis showed that adjuvant interferon therapy was not cost-effective (ICER = dollars 27000/year) if the annual incidence of recurrent hepatocellular carcinoma after interferon is 16% (baseline 8.9%). The proportions of patients with recurrent hepatocellular carcinoma were 74.4% and 86.9% at the annual recurrence rates after interferon of 16% and 35%, respectively.
Adjuvant interferon therapy after surgical resection of primary hepatitis C-related hepatocellular carcinoma improves life expectancy through suppression of recurrent cancer with acceptable cost-effectiveness.
评估辅助性干扰素疗法联合手术切除丙型肝炎相关原发性肝细胞癌的成本效益。
我们构建了一个马尔可夫模型，模拟丙型肝炎相关肝细胞癌切除术后的辅助性干扰素疗法，并评估预期寿命、成本和癌症复发情况。参考病例为一名60岁的丙型肝炎相关代偿性肝硬化男性。
在基线时，辅助性干扰素疗法产生6.1个生命年，成本为77000美元，与不使用干扰素疗法相比，增量成本效益比为15700美元/生命年。使用辅助性干扰素疗法，直至死亡时发生肝细胞癌复发的患者比例从87.6%降至62.9%。干扰素治疗后复发性肝细胞癌的发生率影响辅助性干扰素疗法的成本效益。阈值分析表明，如果干扰素治疗后复发性肝细胞癌的年发生率为16%（基线为8.9%），辅助性干扰素疗法不具有成本效益（ICER = 27000美元/年）。在干扰素治疗后年复发率分别为16%和35%时，复发性肝细胞癌患者的比例分别为74.4%和86.9%。
丙型肝炎相关原发性肝细胞癌手术切除后辅助性干扰素疗法通过抑制复发性癌症提高预期寿命，且具有可接受的成本效益。
