Almeida Alessandra Maciel, Silva Anderson Lourenço da, Brandão Cristina Mariano Ruas, Cherchiglia Mariângela Leal, Andrade Eli Iola Gurgel, Araújo de Oliveira Gustavo Laine, Carmo Ricardo Andrade, Acurcio Francisco de Assis
Programa de Pós-Graduação em Saúde Pública, Departamento de Medicina, Preventiva e Social., Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Rev Saude Publica. 2012 Dec;46(6):942-9.
To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB).
Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg- negative) with a 40-year 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.
Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine.
The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection.
对慢性乙型肝炎（CHB）患者因病毒耐药复发时采用挽救治疗的药物替代方案进行成本效益分析。
假设的CHB患者队列，HBeAg阴性，无肝硬化的临床或组织学证据，可检测到HBV DNA，疾病组织学诊断明确，血清HBsAg阳性超过6个月，丙氨酸氨基转移酶（ALT）水平高（高于正常上限两倍），平均年龄40岁。针对慢性乙型肝炎（HBeAg阴性）构建了一个40年时间跨度的马尔可夫模型。成本和效益按5%进行贴现。疾病进展的年发生率、并发症成本和药物疗效从文献中获取。单向和概率敏感性分析评估不确定性。
与拉米夫定相比，开始使用恩替卡韦治疗可使贴现生命年增加0.35。增量成本效益比为每获得一个生命年16,416.08雷亚尔。在敏感性分析中，增量成本效益比对从慢性乙型肝炎转变为代偿性肝硬化的概率、贴现率和药品价格的变化（±10%）更为敏感。在概率敏感性分析中，可接受性曲线表明，与使用拉米夫定相比，开始使用恩替卡韦治疗是最具成本效益的选择。
对于未合并HIV感染的慢性乙型肝炎患者，恩替卡韦作为早期治疗的一部分在经济上具有吸引力。
