Biddle A K, Simpson K N
Department of Health Policy and Administration, School of Public Health, University of North Carolina, Chapel Hill, NC, USA.
Value Health. 2000 May-Jun;3(3):186-201. doi: 10.1046/j.1524-4733.2000.33006.x.
In this study, we modify previously published models to estimate the short- and long-term consequences of nevirapine triple combination therapy use in five developed countries. Current pharmacoeconomic practice requires the de novo model development for each new therapy comparison. This approach is lengthy and costly, and it may yield models with very different structures. Standardized, detailed disclosure of model assumptions and parameters makes it possible to recycle published models with minor structural modifications to examine the efficiency of therapies based on new trial data.
Two well-publicized models of HIV therapy are modified to fit new trial data comparing double and triple combination therapy with nevirapine; model parameters are adjusted to represent clinical practice and cost structure in five countries. A short-term model uses trial data from advanced-stage patients to estimate first-year costs and consequences. A long-term model uses data from antiretroviral-naïve patients to estimate long-term cost-effectiveness.
During the first year, for each 100 individuals treated with nevirapine triple combination therapy, 2.7 deaths and 30.8-31.4 opportunistic disease events would be averted compared to employing dual therapy. Additionally, 61% to 142% of the first-year costs of nevirapine therapy would be offset by other medical care costs savings [FF19,749, DM3,778, 3334 (x1000) lire, 293 (x1000) ptas, and US $3,569]. Compared to dual combination therapy, nevirapine triple combination therapy is predicted to yield incremental cost-effectiveness ratios (discounted at 3%) of FF101,057, DM30,709, 28,066 (x1000) lire, 1294 (x1000) ptas, and US $14,338.
Published, well-constructed, and documented cost-effectiveness models can be reused to estimate the economic impact of therapies for HIV disease. Such models can also be used to provide insight into the factors that affect efficiency across countries. Our use of clinical trial data on nevirapine, together with published HIV economic models, provides support for the hypothesis that nevirapine is cost-effective under the cost structures of five developed countries.
在本研究中，我们对先前发表的模型进行修改，以估计奈韦拉平三联联合疗法在五个发达国家使用的短期和长期后果。当前的药物经济学实践要求为每次新的疗法比较重新开发模型。这种方法冗长且成本高昂，并且可能产生结构差异很大的模型。对模型假设和参数进行标准化、详细的披露，使得在进行微小结构修改后能够重新使用已发表的模型，以便根据新的试验数据来检验疗法的有效性。
对两个广为人知的HIV治疗模型进行修改，以拟合比较奈韦拉平双联和三联联合疗法的新试验数据；调整模型参数以代表五个国家的临床实践和成本结构。一个短期模型使用晚期患者的试验数据来估计第一年的成本和后果。一个长期模型使用从未接受过抗逆转录病毒治疗的患者的数据来估计长期成本效益。
在第一年，与采用双联疗法相比，每100名接受奈韦拉平三联联合疗法治疗的个体中，可避免2.7例死亡和30.8 - 31.4例机会性疾病事件。此外，奈韦拉平疗法第一年成本的61%至142%将被其他医疗保健成本节省所抵消[法国法郎19,749、德国马克3,778、3334（×1000）里拉、293（×1000）比塞塔以及3,569美元]。与双联联合疗法相比，预计奈韦拉平三联联合疗法产生的增量成本效益比（按3%贴现）为法国法郎101,057、德国马克30,709、28,066（×1000）里拉、1294（×1000）比塞塔以及14,338美元。
已发表的、构建良好且有文献记录的成本效益模型可重新用于估计HIV疾病疗法的经济影响。此类模型还可用于深入了解影响各国效率的因素。我们对奈韦拉平临床试验数据的使用，以及已发表的HIV经济模型，为奈韦拉平在五个发达国家成本结构下具有成本效益这一假设提供了支持。
