Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais, Brazil.
Value Health. 2011 Jul-Aug;14(5 Suppl 1):S24-8. doi: 10.1016/j.jval.2011.05.011.
To perform a cost-effectiveness evaluation from the perspective of the Brazilian National Health System of alternatives strategies (i.e., conventional interferon, pegylated interferon, and lamivudine) for the treatment of patients with chronic hepatitis B who present elevated aminotransferase levels and no evidence of cirrhosis at the beginning of treatment.
A Markov model was developed for chronic hepatitis B (hepatitis B antigen e [HBeAg] positive and negative) with 40 years' time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications, and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties.
For HBeAg positive patients, peginterferon (48 weeks) resulted in an increase of 0.21 discounted life-years gained compared to interferon (24 weeks). The incremental cost-effectiveness ratio (ICER) converted to US dollars using the 2009 purchasing power parity conversion factor was US$100,752.24 per life-year gained. For HBeAg negative patients, it was observed that interferon (48 weeks) compared with long-term lamivudine presented an increase of 0.45 discounted life-years gained and ICER of US$15,766.90 per life-year gained. In the sensitivity analysis, the ICER was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate, and medicine prices. Cost-effectiveness acceptability curve for HBeAg positive (pegylated interferon vs. conventional interferon) and negative (conventional interferon vs. lamivudine) showed that conventional interferon was cost-effective until three times the gross domestic product per capita.
For patients with chronic hepatitis B with elevated aminotransferase levels in the pretreatment and no cirrhosis who were HBeAg positive, pegylated interferon (48 weeks) provided more life-years gained when compared to conventional interferon (24 weeks), and the ICER surpasses the country's buying power, which makes conventional interferon the chosen alternative. For HBeAg negative patients, conventional interferon (48 weeks) compared to lamivudine provided more life-years gained at a favorable ICER.
从巴西国家卫生系统的角度出发，对治疗初治时天门冬氨酸氨基转移酶（AST）升高且无肝硬化证据的慢性乙型肝炎患者的替代方案（即普通干扰素、聚乙二醇干扰素和拉米夫定）进行成本效果评估。
建立了一个具有 40 年时间范围的慢性乙型肝炎（乙型肝炎表面抗原[e]阳性和阴性）的马尔可夫模型。成本和效益以 5%的贴现率贴现。疾病进展的年发生率、并发症相关成本以及药物疗效均从文献中获得。单因素敏感性分析和概率敏感性分析评估了不确定性。
对于 HBeAg 阳性患者，与干扰素（24 周）相比，聚乙二醇干扰素（48 周）可使折后生命年增加 0.21 年。使用 2009 年购买力平价转换系数转换为美元的增量成本效果比（ICER）为每获得 1 个生命年需花费 100752.24 美元。对于 HBeAg 阴性患者，干扰素（48 周）与长期拉米夫定相比，折后生命年增加了 0.45 年，ICER 为每获得 1 个生命年需花费 15766.90 美元。在敏感性分析中，ICER 对慢性乙型肝炎向代偿性肝硬化的转化率、贴现率和药物价格的变化更为敏感。HBeAg 阳性（聚乙二醇干扰素与普通干扰素）和阴性（普通干扰素与拉米夫定）的成本效果接受性曲线表明，普通干扰素的成本效果直到达到人均国内生产总值的三倍时才具有优势。
对于初治时 AST 升高且无肝硬化的 HBeAg 阳性慢性乙型肝炎患者，聚乙二醇干扰素（48 周）比普通干扰素（24 周）能获得更多的生命年，且 ICER 超过了该国的购买力，因此普通干扰素是更优选择。对于 HBeAg 阴性患者，与拉米夫定相比，普通干扰素（48 周）能获得更多的生命年，且 ICER 有利。
