聚乙二醇干扰素 alfa-2B 联合利巴韦林治疗巴西慢性丙型肝炎的成本效益。

Cost effectiveness of peginterferon alfa-2B combined with ribavirin for the treatment of chronic hepatitis C in Brazil.

机构信息

Federal University of São Paulo, São Paulo, SP, Brazil.

出版信息

Braz J Infect Dis. 2009 Jun;13(3):191-9. doi: 10.1590/s1413-86702009000300007.

DOI:10.1590/s1413-86702009000300007

PMID:20191195

Abstract

The treatment of chronic hepatitis C (CHC) with peginterferon alpha-2b/ribavirin (PegIFN + Rib) produced larger sustained viral response (SVR) compared to the conventional (non-pegylated) interferon/ribavirin (IFN + Rib), but its cost-effectiveness was not assessed in Brazil. We developed a Markov model to mirror the natural disease history and cohorts of patients with hepatitis C virus (HCV), that received PegIFN + Rib or IFN + Rib treatment for 48 or 24 weeks, according to viral genotype and liver histology. The SVRs for the treatments PegIFN + Rib and IFN + Rib were respectively 48% and 34% (genotype 1), and 88% and 80% (genotype non-1). Three Delphi panels were conducted with hepatologists and intensivists, and another one with oncologists. The costs are expressed in 2006 Brazilian Reais (R$) and the benefits were discounted at 3%. In genotype 1 HCV patients, PegIFN + Rib increases the life expectancy (LE) in 0.51 year, and the quality-adjusted life years (QALY) in 0.78, as compared to IFN + Rib. In genotype non-1 HCV patients, PegIFN + Rib increases the LE in 0.29 years and the QALY in 0.44 years, as compared to IFN + Rib. The incremental cost-effectiveness rate, considering all the genotypes, was of R$19,848.34 per QALY. Peginterferon alpha-2b with ribavirin is a cost-effective therapy for the treatment of naïve CHC adult patients compared to the interferon alpha-2b and ribavirin regime, irrespective of the viral genotype.

摘要

聚乙二醇干扰素 α-2b/利巴韦林（PegIFN + Rib）治疗慢性丙型肝炎（CHC）比传统（非聚乙二醇化）干扰素/利巴韦林（IFN + Rib）产生更大的持续病毒应答（SVR），但其成本效益并未在巴西进行评估。我们开发了一个马尔可夫模型，以反映自然疾病史和丙型肝炎病毒（HCV）患者队列，这些患者根据病毒基因型和肝组织学接受 PegIFN + Rib 或 IFN + Rib 治疗 48 或 24 周。PegIFN + Rib 和 IFN + Rib 治疗的 SVR 分别为 48%和 34%（基因型 1），88%和 80%（基因型非 1）。我们进行了三次德尔菲小组讨论，分别有肝病学家和重症监护医生，以及一次与肿瘤学家进行的讨论。成本以 2006 年巴西雷亚尔（R$）表示，效益以 3%贴现。在基因型 1 HCV 患者中，与 IFN + Rib 相比，PegIFN + Rib 可使预期寿命（LE）延长 0.51 年，使质量调整生命年（QALY）延长 0.78 年。在基因型非 1 HCV 患者中，与 IFN + Rib 相比，PegIFN + Rib 使 LE 延长 0.29 年，使 QALY 延长 0.44 年。考虑到所有基因型，增量成本效益比为每 QALY 19,848.34 雷亚尔。聚乙二醇干扰素 α-2b 联合利巴韦林治疗初治 CHC 成年患者，与干扰素 α-2b 联合利巴韦林方案相比，具有成本效益，与病毒基因型无关。