Kanwal Fasiha, Gralnek Ian M, Martin Paul, Dulai Gareth S, Farid Mary, Spiegel Brennan M R
Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine at University of California, Los Angeles, and Center for the Study of Digestive Healthcare Quality and Outcomes, Los Angeles, California 90073, USA.
Ann Intern Med. 2005 May 17;142(10):821-31. doi: 10.7326/0003-4819-142-10-200505170-00007.
Treatment options for chronic hepatitis B virus (HBV) infection have disparate risks and benefits. Interferon has clinically significant side effects, and lamivudine is associated with viral resistance. In contrast, adefovir is safe and has lower viral resistance but is more expensive. The most cost-effective approach is uncertain.
To determine whether and under what circumstances the improved efficacy of adefovir offsets its increased cost compared with lamivudine or interferon.
Cost-utility analysis stratified by hepatitis B e antigen (HBeAg) status.
Systematic review of MEDLINE from 1970 to 2005.
Patients with chronic HBV infection, elevated aminotransferase levels, and no cirrhosis.
Lifetime.
Third-party payer.
Incremental cost per quality-adjusted life-year (QALY) gained.
RESULTS OF BASE-CASE ANALYSIS: The "do nothing" strategy was least effective yet least expensive. Compared with the "do nothing" strategy, using interferon cost an incremental 6337 dollars to gain 1 additional QALY. Compared with interferon, the adefovir salvage strategy cost an incremental 8446 dollars per QALY gained. Both the lamivudine and adefovir monotherapy strategies were more expensive yet less effective than the alternative strategies and were therefore dominated.
In sensitivity analysis, interferon was most cost-effective in health care systems with tight budgetary constraints and a high prevalence of HBeAg-negative patients.
These results apply only to patients with chronic HBV infection, elevated aminotransferase levels, and no clinical or histologic evidence of cirrhosis. They do not apply to alternative populations.
Neither lamivudine nor adefovir monotherapy is cost-effective in chronic HBV infection. However, a hybrid salvage strategy reserving adefovir only for lamivudine-associated viral resistance may be highly cost-effective across most health care settings. Interferon therapy may still be preferred in health care systems with limited resources, especially in those serving populations with a high prevalence of HBeAg-negative HBV.
慢性乙型肝炎病毒（HBV）感染的治疗方案具有不同的风险和益处。干扰素具有临床上显著的副作用，而拉米夫定与病毒耐药性有关。相比之下，阿德福韦安全且病毒耐药性较低，但费用更高。最具成本效益的方法尚不确定。
确定与拉米夫定或干扰素相比，阿德福韦疗效的提高是否以及在何种情况下能够抵消其增加的成本。
按乙肝e抗原（HBeAg）状态分层的成本效益分析。
对1970年至2005年MEDLINE的系统评价。
慢性HBV感染、转氨酶水平升高且无肝硬化的患者。
终身。
第三方支付者。
1）不进行HBV治疗（“不采取任何措施”策略），2）干扰素单药治疗，3）拉米夫定单药治疗，4）阿德福韦单药治疗，或5）拉米夫定耐药后换用阿德福韦（“阿德福韦挽救”策略）。
每获得一个质量调整生命年（QALY）的增量成本。
“不采取任何措施”策略效果最差但成本最低。与“不采取任何措施”策略相比，使用干扰素获得1个额外的QALY需增加成本6337美元。与干扰素相比，阿德福韦挽救策略每获得一个QALY需增加成本8446美元。拉米夫定和阿德福韦单药治疗策略均比替代策略成本更高且效果更差，因此被主导。
在敏感性分析中，在预算紧张且HBeAg阴性患者患病率高的医疗保健系统中，干扰素最具成本效益。
这些结果仅适用于慢性HBV感染、转氨酶水平升高且无临床或组织学肝硬化证据的患者。不适用于其他人群。
拉米夫定和阿德福韦单药治疗在慢性HBV感染中均不具有成本效益。然而，一种仅在拉米夫定相关病毒耐药时使用阿德福韦的混合挽救策略在大多数医疗保健环境中可能具有很高的成本效益。在资源有限的医疗保健系统中，尤其是在服务于HBeAg阴性HBV患病率高的人群的系统中，干扰素治疗可能仍然是首选。
Zotero 插件