Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, USA.
Liver Transpl. 2010 Jun;16(6):748-59. doi: 10.1002/lt.22072.
Antiviral therapy for the treatment of hepatitis C virus (HCV) infection is used before and after liver transplantation. The objective of this study was to determine the most cost-effective timing for pegylated interferon/ribavirin therapy in patients with advanced liver disease infected with genotype 1 HCV. A Markov model was constructed to compare treatment strategies: (1) no treatment, (2) antiviral therapy in patients with compensated cirrhosis, (3) antiviral therapy in patients with decompensated cirrhosis, and (4) antiviral therapy in patients with progressive fibrosis due to recurrent HCV post-transplantation. Outcomes of interest included the total cost per patient, number of quality-adjusted life years (QALYs) saved, cost per QALY saved, number of deaths and hepatocellular carcinomas (HCCs), and number of transplants required. Compared to the no-antiviral treatment strategy, treatment during compensated cirrhosis increased QALYs by 0.950 and saved $55,314. Treatment during decompensated cirrhosis increased QALYs by 0.044 and saved $5511. Treatment during posttransplant advanced recurrence increased QALYs by 0.061 and saved $3223. Treatment of patients with compensated cirrhosis resulted in 119 fewer deaths, 54 fewer HCCs, and 66 fewer transplants with respect to the no-treatment strategy. The model was sensitive to the rate of graft failure in patients with and without sustained virological response. The model was otherwise robust to all variables tested in sensitivity analysis. In conclusion, the treatment of patients with compensated cirrhosis was found to be the most cost-effective strategy and resulted in improved survival and decreased cost in comparison with all other strategies. This study provides pharmacoeconomic evidence in support of treating HCV in patients with compensated cirrhosis before progression to more advanced liver disease.
抗病毒疗法用于治疗丙型肝炎病毒 (HCV) 感染，可在肝移植前后使用。本研究的目的是确定基因型 1 HCV 感染的晚期肝病患者接受聚乙二醇干扰素/利巴韦林治疗的最具成本效益的时机。构建了一个 Markov 模型来比较治疗策略：(1) 不治疗，(2) 代偿性肝硬化患者的抗病毒治疗，(3) 失代偿性肝硬化患者的抗病毒治疗，(4) 因移植后 HCV 复发而导致进行性纤维化的患者的抗病毒治疗。感兴趣的结果包括每位患者的总费用、节省的质量调整生命年 (QALY) 数量、每节省一个 QALY 的成本、死亡和肝细胞癌 (HCC) 的数量，以及所需的移植数量。与无抗病毒治疗策略相比，代偿性肝硬化期间的治疗增加了 0.950 个 QALY，并节省了 55314 美元。失代偿性肝硬化期间的治疗增加了 0.044 个 QALY，并节省了 5511 美元。移植后 advanced recurrence 期间的治疗增加了 0.061 个 QALY，并节省了 3223 美元。与无治疗策略相比，代偿性肝硬化患者的治疗导致死亡人数减少 119 人，HCC 减少 54 人，移植减少 66 人。该模型对有和无持续病毒学应答患者的移植物失效率敏感。在敏感性分析中，该模型对所有测试变量均具有稳健性。总之，与所有其他策略相比，治疗代偿性肝硬化患者被发现是最具成本效益的策略，可提高生存率并降低成本。本研究提供了药物经济学证据，支持在进展为更严重的肝病之前治疗代偿性肝硬化患者的 HCV。
