Pwu Raoh-Fang, Chan K Arnold
Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei.
J Formos Med Assoc. 2002 Sep;101(9):632-41.
Although interferon-alpha has been approved for chronic hepatitis B treatment in Taiwan, the high price necessitates study of its cost-effectiveness to define its role from a burden of disease perspective.
A stimulation model was constructed to project the long-term effects of interferon treatment or standard care for a hypothetical group of 35-year-old chronic hepatitis B patients in Taiwan. Data on interferon treatment efficacy, disease progression, vital statistics, medical expenditure for various liver disease states, and quality-of-life measures based on Taiwan data were collected and used in the model.
The model indicated that a 35-year-old chronic hepatitis B patient treated with interferon in Taiwan would have a life expectancy of 29.08 years, versus 28.67 years for the same patient who did not receive interferon. Corresponding to this gain in life expectancy of 0.41 years (or 0.18 quality-adjusted life-years, QALYs), the incremental cost-effectiveness ratio (ICER) was 492.000 New Taiwan dollars (NT$; 14,200 US$ at 34.7 NT$/US$) per QALY with an annual 3% discount rate. Monte Carlo simulation taking into account the range of plausible values for all model parameters indicated that 95% of the ICERs were in the range of 65,000 NT$ (1.900 US$)/QALY to 683,000 NT$ (19,700 US$)/QALY, and 90% of the ICERs were below 413,000 NT$ (11,900 US$)/QALY.
Interferon has a favorable cost-effectiveness profile in the treatment of chronic hepatitis B in Taiwan. However, the study results cannot be interpreted in isolation and need to be compared with the cost-effectiveness profiles of treatment regimens for other major chronic diseases in Taiwan.
尽管α干扰素已在台湾获批用于慢性乙型肝炎的治疗，但因其价格高昂，有必要对其成本效益进行研究，以便从疾病负担的角度明确其作用。
构建了一个模拟模型，以预测对台湾一组假设的35岁慢性乙型肝炎患者进行干扰素治疗或标准治疗的长期效果。收集了基于台湾数据的干扰素治疗疗效、疾病进展、人口统计数据、各种肝病状态的医疗支出以及生活质量指标等数据，并将其用于该模型。
该模型表明，在台湾接受干扰素治疗的35岁慢性乙型肝炎患者的预期寿命为29.08岁，而未接受干扰素治疗的同一名患者的预期寿命为28.67岁。对应于预期寿命增加0.41年（或0.18个质量调整生命年，QALY），在年贴现率为3%的情况下，增量成本效益比（ICER）为每QALY 492,000新台币（按34.7新台币/美元换算为14,200美元）。考虑到所有模型参数的合理取值范围进行的蒙特卡洛模拟表明，95%的ICER在65,000新台币（1,900美元）/QALY至683,000新台币（19,700美元）/QALY范围内，90%的ICER低于413,000新台币（11,900美元）/QALY。
在台湾，干扰素治疗慢性乙型肝炎具有良好的成本效益。然而，该研究结果不能孤立地进行解读，需要与台湾其他主要慢性病治疗方案的成本效益情况进行比较。
