García-Contreras Fernando, Nevárez-Sida Armando, Constantino-Casas Patricia, Abud-Bastida Fernando, Garduño-Espinosa Juan
Unidad de Investigación en Economía de la Salud, Coordinación de Investigación en Salud, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico.
Arch Med Res. 2006 Jul;37(5):663-73. doi: 10.1016/j.arcmed.2005.11.010.
More than one million individuals in Mexico are infected with hepatitis C virus (HCV), and 80% are at risk for developing a chronic infection that could lead to hepatic cirrhosis and other complications that impact quality of life and institutional costs. The objective of the study was to determine the most cost-effective treatment against HCV among the following: peginterferon, peginterferon plus ribavirin, peginterferon plus ribavirin plus thymosin, and no treatment.
We carried out cost-effectiveness analysis using the institutional perspective, including a 45-year time frame and a 3% discount rate for costs and effectiveness. We employed a Bayesian-focused decision tree and a Markov model. One- and two-way sensitivity analyses were performed, as well as threshold-oriented and probabilistic analyses, and we obtained acceptability curves and net health benefits.
Triple therapy (peginterferon plus ribavirin plus thymosin alpha-1) was dominant with lower cost and higher utility in relationship with peginterferon + ribavirin option, peginterferon alone and no-treatment option. In triple therapy the cost per unit of success was of 1,908 [USD/quality-adjusted life years (QALY)] compared with peginterferon plus ribavirin 2,277/QALY, peginterferon alone 2,929/QALY, and no treatment 4,204/QALY. Sensitivity analyses confirmed the robustness of the base case.
Peginterferon plus ribavirin plus thymosin alpha-1 option was dominant (lowest cost and highest effectiveness). Using no drug was the most expensive and least effective option.
墨西哥有超过100万人感染丙型肝炎病毒（HCV），其中80%有发展为慢性感染的风险，这可能导致肝硬化和其他影响生活质量及机构成本的并发症。本研究的目的是确定在以下治疗方案中针对HCV最具成本效益的治疗方法：聚乙二醇干扰素、聚乙二醇干扰素加利巴韦林、聚乙二醇干扰素加利巴韦林加胸腺素，以及不治疗。
我们从机构角度进行成本效益分析，包括45年的时间框架以及3%的成本和效益贴现率。我们采用了贝叶斯聚焦决策树和马尔可夫模型。进行了单向和双向敏感性分析，以及阈值导向和概率分析，并获得了可接受性曲线和净健康效益。
三联疗法（聚乙二醇干扰素加利巴韦林加胸腺素α-1）与聚乙二醇干扰素+利巴韦林方案、单独使用聚乙二醇干扰素和不治疗方案相比，具有成本更低和效用更高的优势。在三联疗法中，每成功治疗单位的成本为1908美元/质量调整生命年（QALY），而聚乙二醇干扰素加利巴韦林为2277美元/QALY，单独使用聚乙二醇干扰素为2929美元/QALY，不治疗为4204美元/QALY。敏感性分析证实了基础病例的稳健性。
聚乙二醇干扰素加利巴韦林加胸腺素α-1方案具有优势（成本最低且效果最佳）。不使用药物是最昂贵且效果最差的选择。
