Garcia de Ancos J L, Roberts J A, Dusheiko G M
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom.
J Hepatol. 1990;11 Suppl 1:S11-8. doi: 10.1016/0168-8278(90)90157-m.
An economic evaluation to compare the costs of care and likely outcome for patients treated with alpha-interferon for chronic active hepatitis B and C was performed. As complete prospective data are not available, we have made comparisons between two cohorts of 100 hypothetical patients. Treatment of chronic hepatitis B would be with alpha-interferon at an average dose of 9 million units three times per week for 16 weeks. Chronic active hepatitis C treatment is based on a dose of 3 million units three times weekly for a total of 6 months. In untreated patients with chronic active hepatitis B or C, the risk of developing cirrhosis is considered to be 10-20% in a 10-year period. Patterns of good practice are costed using typical costs of patients in our institution. These costs are aggregated using the probabilities of morbidity and mortality, from therapeutic and epidemiological studies, for patients developing cirrhosis. A sensitivity analysis has been applied to the results. If we assume a latency period of 10 years, the costs of a successfully treated patient with both hepatitis B and C will be recouped. For hepatitis C, benefits are apparent when social costs are added, the price of alpha-interferon is reduced by 10% and the response rate raised by 20%. Nevertheless, if morbidity effects and costs to patients are included, the advantages of treatment are more apparent, with potential savings in both chronic hepatitis B and C. The model we have developed can be adapted as firmer evidence becomes available.
对接受α-干扰素治疗的慢性活动性乙型和丙型肝炎患者的护理成本和可能的治疗结果进行了一项经济学评估。由于没有完整的前瞻性数据，我们对两组各100名假设患者进行了比较。慢性乙型肝炎的治疗采用α-干扰素，平均剂量为每周三次，每次900万单位，共16周。慢性活动性丙型肝炎的治疗基于每周三次，每次300万单位，共6个月的剂量。在未经治疗的慢性活动性乙型或丙型肝炎患者中，10年内发生肝硬化的风险被认为是10%-20%。良好实践模式的成本是根据我们机构患者的典型成本计算的。这些成本使用治疗和流行病学研究中肝硬化患者发病和死亡的概率进行汇总。对结果进行了敏感性分析。如果我们假设潜伏期为10年，成功治疗的乙型和丙型肝炎患者的成本将得到补偿。对于丙型肝炎，当加上社会成本、α-干扰素价格降低10%且反应率提高20%时，益处就很明显。然而，如果将发病影响和患者成本包括在内，治疗的优势会更加明显，在慢性乙型和丙型肝炎中都可能节省成本。随着更确凿的证据出现，我们开发的模型可以进行调整。
