Gimeno-Ballester Vicente, Mar Javier, San Miguel Ramón
a 1 Hospital Universitario Miguel Servet-Pharmacy Department, Isabel la Católica 1-3, Zaragoza, Zaragoza 50009, Spain.
d 4 Faculty of Pharmacy, University of Granada, Granada, Spain.
Expert Rev Pharmacoecon Outcomes Res. 2016;16(2):285-94. doi: 10.1586/14737167.2015.1081061. Epub 2015 Aug 29.
The cost of interferon-free combination therapies remains high to provide widespread access to treatment, regardless of fibrosis stage.
To estimate the cost-effectiveness of simeprevir/daclatasvir (SMV/DCV) therapy in treatment-naïve chronic hepatitis C genotype-1b patients with moderate fibrosis.
A Markov model was developed to simulate the natural history of chronic hepatitis C progression. The model estimated lifetime healthcare costs and quality-adjusted life-years (QALY) for a cohort of patients from the Spanish National Healthcare System perspective. The cost-effectiveness threshold considered was €40,000/QALY. The treatment strategies analyzed were SMV/DCV, peginterferon/ribavirin/telaprevir, and peginterferon/ribavirin/boceprevir. A sensitivity analysis was carried out.
The incremental cost-effectiveness ratios of the SMV/DCV strategy were €23,774/QALY and €28,524/QALY compared with that of telaprevir or boceprevir triple therapy, respectively, for genotype-1b patients with moderate fibrosis.
SMV/DCV combination compared with the standard of care previous to the arrival of second-generation direct-acting antivirals fell below generally accepted willingness-to-pay threshold. Results obtained should be supported by ongoing clinical trials.
无论纤维化阶段如何，无干扰素联合疗法的成本仍然很高，难以广泛普及治疗。
评估西米普明/达卡他韦（SMV/DCV）疗法对初治的中度纤维化慢性丙型肝炎基因1b型患者的成本效益。
建立马尔可夫模型以模拟慢性丙型肝炎进展的自然史。该模型从西班牙国家医疗保健系统的角度估算了一组患者的终身医疗保健成本和质量调整生命年（QALY）。所考虑的成本效益阈值为40,000欧元/QALY。分析的治疗策略为SMV/DCV、聚乙二醇干扰素/利巴韦林/特拉匹韦和聚乙二醇干扰素/利巴韦林/博赛泼维。进行了敏感性分析。
对于中度纤维化的基因1b型患者，与特拉匹韦或博赛泼维三联疗法相比，SMV/DCV策略的增量成本效益比分别为23,774欧元/QALY和28,524欧元/QALY。
与第二代直接作用抗病毒药物出现之前的标准治疗相比，SMV/DCV联合疗法低于普遍接受的支付意愿阈值。所得结果应由正在进行的临床试验予以支持。
