Pfeil Alena M, Reich Oliver, Guerra Ines M, Cure Sandrine, Negro Francesco, Müllhaupt Beat, Lavanchy Daniel, Schwenkglenks Matthias
Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
Department of Health Sciences, Helsana Group, Zurich, Switzerland.
PLoS One. 2015 May 14;10(5):e0126984. doi: 10.1371/journal.pone.0126984. eCollection 2015.
In clinical trials, sofosbuvir showed high antiviral activity in patients infected with hepatitis C virus (HCV) across all genotypes. We aimed to determine the cost-effectiveness of sofosbuvir-based treatment compared to current standard treatment in mono-infected patients with chronic hepatitis C (CHC) genotypes 1-4 in Switzerland. Cost-effectiveness was modelled from the perspective of the Swiss health care system using a lifetime Markov model. Incremental cost-effectiveness ratios (ICERs) used an endpoint of cost per quality-adjusted life year (QALY) gained. Treatment characteristics, quality of life, and transition probabilities were obtained from published literature. Country-specific model inputs such as patient characteristics, mortality and costs were obtained from Swiss sources. We performed extensive sensitivity analyses. Costs and effects were discounted at 3% (range: 0-5%) per year. Sofosbuvir-containing treatment in mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 showed ICERs between CHF 10,337 and CHF 91,570 per QALY gained. In subgroup analyses, sofosbuvir dominated telaprevir- and boceprevir-containing treatment in treatment-naïve genotype 1 cirrhotic patients. ICERs of sofosbuvir were above CHF 100,000 per QALY in treatment-naïve, interferon eligible, non-cirrhotic patients infected with genotypes 2 or 3. In deterministic and probabilistic sensitivity analyses, results were generally robust. From a Swiss health care system perspective, treatment of mixed cohorts of cirrhotic and non-cirrhotic patients with CHC genotypes 1-4 with sofosbuvir-containing treatment versus standard treatment would be cost-effective if a threshold of CHF 100,000 per QALY was assumed.
在临床试验中，索磷布韦对所有基因型丙型肝炎病毒（HCV）感染患者均显示出高抗病毒活性。我们旨在确定在瑞士，与目前慢性丙型肝炎（CHC）1-4型单感染患者的标准治疗相比，基于索磷布韦的治疗的成本效益。从瑞士医疗保健系统的角度，使用终身马尔可夫模型对成本效益进行建模。增量成本效益比（ICER）采用每获得一个质量调整生命年（QALY）的成本作为终点。治疗特征、生活质量和转移概率均来自已发表的文献。特定国家的模型输入，如患者特征、死亡率和成本，均来自瑞士的资料来源。我们进行了广泛的敏感性分析。成本和效果按每年3%（范围：0-5%）进行贴现。在CHC 1-4型肝硬化和非肝硬化患者的混合队列中，含索磷布韦的治疗每获得一个QALY的ICER在10337瑞士法郎至91570瑞士法郎之间。在亚组分析中，索磷布韦在初治1型肝硬化基因型患者中优于含特拉匹韦和波普瑞韦的治疗。在初治、符合使用干扰素条件、非肝硬化的2型或3型感染患者中，索磷布韦的ICER高于每QALY 100,000瑞士法郎。在确定性和概率性敏感性分析中，结果总体稳健。从瑞士医疗保健系统的角度来看，如果假设每QALY的阈值为100,000瑞士法郎，那么用含索磷布韦的治疗方案治疗CHC 1-4型肝硬化和非肝硬化患者的混合队列与标准治疗相比将具有成本效益。
