Veenstra David L, Sullivan Sean D, Dusheiko Geoffry M, Jacobs Michael, Aledort Julia E, Lewis Gavin, Patel Kavita K
University of Washington, Seattle, Washington 98195, USA.
Eur J Gastroenterol Hepatol. 2007 Aug;19(8):631-8. doi: 10.1097/MEG.0b013e3281108079.
Peginterferon alpha-2a (40 kDa), a new treatment for chronic hepatitis B, produces seroconversion within 48 weeks in approximately 32% of HBeAg-positive patients. Over a defined treatment duration it offers improved efficacy over lamivudine, but at higher cost. We assessed the clinical outcomes and costs, from the perspective of the UK National Health Service, of 48 weeks of peginterferon alpha-2a (40 kDa) vs. 4 years of lamivudine.
Cost-effectiveness was analysed using a state-transition Markov model simulating HBeAg-positive chronic hepatitis B natural history. Efficacy data were obtained from a large randomized trial comparing peginterferon alpha-2a (40 kDa) with lamivudine over 48 weeks. Use of adefovir salvage treatment for lamivudine-resistant patients was also evaluated. Long-term lamivudine efficacy, treatment durability, disease progression, cost, and quality-of-life estimates were derived from the literature. One-way and probabilistic sensitivity analyses evaluated uncertainty.
Treatment with peginterferon alpha-2a (40 kDa) for 48 weeks resulted in higher discounted total healthcare costs ( pound 3100), but an increase of 0.3 discounted quality-adjusted life years compared with long-term lamivudine, giving an incremental cost-effectiveness ratio of pound 10,400 per quality-adjusted life year gained ( pound 8300- pound 15,400 in one-way sensitivity analyses). The cost-effectiveness acceptability curve showed intervention was below the pound 30,000/QALY threshold in over 95% of the simulations. When adefovir was included for patients with lamivudine resistance, peginterferon alpha-2a (40 kDa) had an incremental cost of pound 6100/QALY gained.
Treatment with peginterferon alpha-2a (40 kDa) for a defined duration of 48 weeks, although more expensive than lamivudine therapy, provides improvement in health outcomes, with a cost-effectiveness ratio well below the current UK cost-effectiveness threshold.
聚乙二醇化干扰素α-2a（40 kDa）是一种治疗慢性乙型肝炎的新药物，在48周内可使约32%的HBeAg阳性患者发生血清学转换。在规定的治疗疗程内，它比拉米夫定疗效更好，但成本更高。我们从英国国家医疗服务体系的角度评估了48周聚乙二醇化干扰素α-2a（40 kDa）与4年拉米夫定治疗的临床结果和成本。
采用状态转换马尔可夫模型分析成本效益，该模型模拟HBeAg阳性慢性乙型肝炎的自然病程。疗效数据来自一项大型随机试验，该试验比较了聚乙二醇化干扰素α-2a（40 kDa）与拉米夫定48周的治疗效果。还评估了对拉米夫定耐药患者使用阿德福韦挽救治疗的情况。长期拉米夫定疗效、治疗持久性、疾病进展、成本和生活质量评估均来自文献。单向和概率敏感性分析评估了不确定性。
聚乙二醇化干扰素α-2a（40 kDa）治疗48周导致更高的贴现总医疗成本（3100英镑），但与长期拉米夫定相比，贴现质量调整生命年增加了0.3，每获得一个质量调整生命年的增量成本效益比为10400英镑（单向敏感性分析中为8300 - 15400英镑）。成本效益可接受性曲线显示，在超过95%的模拟中，干预措施低于30000英镑/质量调整生命年的阈值。当对拉米夫定耐药患者使用阿德福韦时，聚乙二醇化干扰素α-2a（40 kDa）每获得一个质量调整生命年的增量成本为6100英镑。
在规定的48周疗程内使用聚乙二醇化干扰素α-2a（40 kDa）治疗，虽然比拉米夫定治疗更昂贵，但能改善健康结果，成本效益比远低于英国目前的成本效益阈值。
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