Buti M, Casado M A, Esteban R
Department of Hepatology, Hospital Vall d'Hebrón, and CiBER de Enfermedades Hepaticas y Digestivas del Instituto de Salud Carlos III, Barcelona, Spain.
Aliment Pharmacol Ther. 2007 Sep 1;26(5):705-16. doi: 10.1111/j.1365-2036.2007.03419.x.
There is a tendency to individualize treatment in chronic hepatitis C patients depending on viral load and rapid clearance of HCV-RNA.
To evaluate the cost (euro, 2006) per sustained virologic response in naïve patients with therapy à la carte compared with standard combination therapy.
A decision analysis model was used to compare standard therapy with peginterferon alpha and ribavirin for 24 weeks for genotype (G) 2/3, and 48 weeks for G1 and therapy à la carte with the same drugs but different durations: G1 high viral load for 48 weeks, G1 low viral load with rapid virologic response for 24 weeks, and without rapid virologic response for 48 weeks, and G2/3 with rapid virologic response for 12 weeks, and without rapid virologic response for 24 weeks.
Sustained virologic response was similar in both strategies. The cost per successfully treated patient for standard therapy is 17,812 euros and for therapy à la carte 12,313 euros. Assuming that 13,309 patients with standard therapy and 14,450 patients with therapy à la carte achieve sustained virologic response, therapy à la carte has an overall cost-saving of 59.13 million euros.
Therapy à la carte is a cost-saving strategy for chronic hepatitis C infection compared to standard therapy, with lower investment requirement per patient to achieve sustained virologic response.
慢性丙型肝炎患者的治疗有根据病毒载量和丙型肝炎病毒核糖核酸（HCV-RNA）快速清除情况进行个体化的趋势。
评估初治患者采用按需治疗与标准联合治疗相比，获得持续病毒学应答的成本（2006年欧元）。
采用决策分析模型，比较聚乙二醇干扰素α和利巴韦林标准治疗方案（基因2/3型治疗24周，基因1型治疗48周）与按需治疗方案（使用相同药物但疗程不同：基因1型高病毒载量治疗48周，基因1型低病毒载量且病毒学应答快速者治疗24周，无快速病毒学应答者治疗48周；基因2/3型有快速病毒学应答者治疗12周，无快速病毒学应答者治疗24周）。
两种策略的持续病毒学应答相似。标准治疗每例成功治疗患者的成本为17,812欧元，按需治疗为12,313欧元。假设13,309例采用标准治疗和14,450例采用按需治疗的患者获得持续病毒学应答，按需治疗总体节省成本5913万欧元。
与标准治疗相比，按需治疗是慢性丙型肝炎感染的一种节省成本的策略，实现持续病毒学应答时每位患者的投资需求更低。
