Stahmeyer J T, Krauth C, Bert F, Pfeiffer-Vornkahl H, Alshuth U, Hüppe D, Mauss S, Rossol S
Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt/M, Germany.
J Viral Hepat. 2016 Feb;23(2):105-15. doi: 10.1111/jvh.12471. Epub 2015 Sep 28.
Viral hepatitis is a major public health problem affecting millions of people worldwide. Long-term consequences are the development of liver cirrhosis and hepatocellular carcinoma. The aim of the study was to assess outcomes and costs of treating patients with chronic hepatitis C in clinical practice in Germany. We carried out a prospective noninterventional study. Information on treatment outcomes, resource utilization and quality of life was provided by 281 physicians throughout Germany. Data of 3708 monoinfected HCV-patients treated between 2008 and 2011 were analysed. Therapy consisted of peginterferon/ribavirin. Mean age of patients was 43.7 years, 60.3% were male and estimated duration of infection was 13.6 years. Predominantly genotype 1 (61.3%) or 3 (28.5%) infections were observed. Sustained viral response (SVR)-rates in most frequently observed genotypes were 49.2% in GT-1 and 61.9% in GT-3 treatment-naive patients (Relapser: GT-1: 35.3% and GT-3: 57.3%; Nonresponder: GT-1: 25.0% and GT-3: 33.3%). Average treatment costs were lowest in treatment-naive patients (€18 965) and higher in patients who failed previous treatments (relapsers: €24 753; nonresponders: €19 511). Differences according to genotype were observed. Average costs per SVR in treatment-naive patients were €44 744 for GT-1 and €22 218 for GT-3. Treatment was associated with a decrease in quality of life; post-treatment quality of life was higher in patients achieving SVR. Our insight on real-life treatment outcomes and costs can serve as a reference for a comparison with other treatments. There is high need for short-term and long-term cost-effectiveness analysis in real-life settings as newly introduced treatment strategies with direct acting antivirals result in high SVR-rates but are more costly.
病毒性肝炎是一个影响全球数百万人的重大公共卫生问题。其长期后果是发展为肝硬化和肝细胞癌。本研究的目的是评估德国临床实践中慢性丙型肝炎患者的治疗结果和成本。我们开展了一项前瞻性非干预性研究。德国各地的281名医生提供了有关治疗结果、资源利用和生活质量的信息。分析了2008年至2011年间接受治疗的3708名单一感染丙型肝炎病毒患者的数据。治疗方案为聚乙二醇干扰素/利巴韦林。患者的平均年龄为43.7岁，60.3%为男性，估计感染持续时间为13.6年。主要观察到基因型1（61.3%）或基因型3（28.5%）感染。在最常观察到的基因型中，初治患者的持续病毒学应答（SVR）率在基因型1中为49.2%，在基因型3中为61.9%（复发者：基因型1为35.3%，基因型3为57.3%；无应答者：基因型1为25.0%，基因型3为33.3%）。平均治疗成本在初治患者中最低（18965欧元），在先前治疗失败的患者中较高（复发者：24753欧元；无应答者：19511欧元）。观察到了基因型之间的差异。初治患者中每例SVR的平均成本在基因型1中为44744欧元，在基因型3中为22218欧元。治疗与生活质量下降相关；实现SVR的患者治疗后的生活质量更高。我们对实际治疗结果和成本的洞察可为与其他治疗方法进行比较提供参考。由于新引入的直接作用抗病毒药物治疗策略导致高SVR率但成本更高，因此在实际环境中对短期和长期成本效益分析的需求很高。
