School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
J Gastroenterol Hepatol. 2012 Jul;27(7):1167-74. doi: 10.1111/j.1440-1746.2011.07047.x.
Tremendous healthcare resources have been spent on the management of chronic hepatitis B (CHB) and its related complications. Therefore, a proper evaluation of the cost-effectiveness of pharmacotherapy is vital in aid of decision-making. The aim of the present study was to examine the long-term economic and clinical influence if lamivudine was replaced by entecavir in a group of CHB patients.
A recently published decision analytic model was adapted to study the cost-effectiveness of 2 years of treatment of entecavir in a hypothetical cohort of 1000 hepatitis B e antigen (HBeAg)-negative CHB patients from a public hospital perspective. Compensated cirrhosis (CC) and de-compensated cirrhosis (DC) and hepatocellular carcinoma (HCC) events were projected to 10 years. Hong Kong-specific health care costs were used. Quality Adjusted Life Years (QALYs) were calculated using the utility values obtained from a local study.
In the base case analysis, compared with lamivudine, the use of entecavir was expected to reduce the incidences of CC, DC and HCC by 41.8%, 57.1% and 49.3%, respectively, and lead to a saving of $US 1.17 million in medical cost. The overall disease management cost for entecavir, which was 67.7% higher than lamivudine for 2 years treatment was reduced to 17.2% after projecting 2-year treatment duration to 10 years. The incremental cost per QALY gained for entecavir compared with lamivudine was $US 13 759.
Based on the recommended cost-effectiveness threshold of the World Health Organization, entecavir is considered cost-effective compared with lamivudine in treating CHB in Hong Kong when long term medical consequences were considered.
大量的医疗资源被用于慢性乙型肝炎（CHB）及其相关并发症的管理。因此，对药物治疗的成本效益进行适当评估对于辅助决策至关重要。本研究旨在评估替比夫定替换恩替卡韦在 CHB 患者中的长期经济和临床影响。
我们改编了最近发表的决策分析模型，以研究从公立医院的角度，1000 例乙型肝炎 e 抗原（HBeAg）阴性 CHB 患者接受恩替卡韦治疗 2 年的成本效益。代偿性肝硬化（CC）和失代偿性肝硬化（DC）和肝细胞癌（HCC）事件预计将持续 10 年。使用香港特定的医疗保健费用。使用本地研究获得的效用值计算质量调整生命年（QALYs）。
在基础案例分析中，与拉米夫定相比，使用恩替卡韦预计可分别降低 CC、DC 和 HCC 的发生率 41.8%、57.1%和 49.3%，并节省医疗费用 117 万美元。在将 2 年的治疗时间延长至 10 年后，恩替卡韦的总体疾病管理成本（比拉米夫定高 67.7%）降低到 17.2%。与拉米夫定相比，恩替卡韦每获得一个 QALY 的增量成本为 13759 美元。
根据世界卫生组织的推荐成本效益阈值，考虑到长期的医疗后果，恩替卡韦在治疗香港的 CHB 方面被认为比拉米夫定更具成本效益。
