Akpo Essè Ifèbi Hervé, Sbarigia Urbano, Wan George, Kleintjens Joris
Deloitte, Berkenlaan 8a, 1831, Diegem, Belgium.
Janssen Pharmaceutica NV, Beerse, Belgium.
Drugs R D. 2015 Dec;15(4):335-49. doi: 10.1007/s40268-015-0109-5.
Limited evidence is available on predictors of medical resource utilization (MRU) and related direct costs, especially in treatment-experienced patients infected with genotype 1 hepatitis C virus (HCV). This study aimed at investigating patient and treatment characteristics that predict MRU and related non-drug costs in treatment-experienced patients with chronic hepatitis C (CHC) treated with simeprevir (SMV) or telapravir (TVR) in combination with pegylated interferon and ribavirin (PegIFN/R).
A total of 709 patients who completed the 72-week ATTAIN trial were included in the study. Cost data were analysed from the UK NHS perspective. Descriptive statistics and regression analyses were used to determine patterns and predictors of total MRU-related costs associated with SMV/PegIFN/R and TVR/PegIFN/R.
Independent predictors for total MRU-related costs were age, region and the following interaction terms: (1) gender × F3-F4 METAVIR score × baseline viral load (BLVL), (2) body mass index (BMI) × F3-F4 METAVIR score × prior response to PegIFN/R and (3) gender × achievement of SVR at 12 weeks (SVR12) × BLVL. A F3-F4 METAVIR score was a stronger predictor of total MRU-related costs than SVR12. Predictors of adverse events included older age, female gender, low BMI, TVR/PegIFN/R and SVR12. Wilcoxon rank sum test revealed comparable total MRU-related costs between SMV/PegIFN/R and TVR/PegIFN/R.
To the best of our knowledge, this study is the first to describe the relationship between commonly admitted predictors of MRU-related costs and their joint effect on total MRU-related costs in treatment-experienced patients with CHC. The identified predictors of MRU-related costs suggest that significant treatment costs can be avoided by starting treatment early before the disease progresses. Furthermore, adverse events seem to be the most important factor to take into consideration for the choice of treatment, especially when therapeutic options are associated with similar levels of medical resource utilization and associated costs.
关于医疗资源利用（MRU）及相关直接成本的预测因素，现有证据有限，尤其是在感染1型丙型肝炎病毒（HCV）且有治疗经验的患者中。本研究旨在调查在接受simeprevir（SMV）或telapravir（TVR）联合聚乙二醇干扰素和利巴韦林（PegIFN/R）治疗的有慢性丙型肝炎（CHC）治疗经验的患者中，预测MRU及相关非药物成本的患者和治疗特征。
本研究纳入了709名完成72周ATTAIN试验的患者。从英国国民健康服务体系（NHS）的角度分析成本数据。使用描述性统计和回归分析来确定与SMV/PegIFN/R和TVR/PegIFN/R相关的总MRU相关成本的模式和预测因素。
总MRU相关成本的独立预测因素为年龄、地区以及以下交互项：（1）性别×F3 - F4 METAVIR评分×基线病毒载量（BLVL），（2）体重指数（BMI）×F3 - F4 METAVIR评分×既往对PegIFN/R的反应，以及（3）性别×12周时持续病毒学应答（SVR）的达成情况（SVR12）×BLVL。F3 - F4 METAVIR评分比SVR12更能预测总MRU相关成本。不良事件的预测因素包括年龄较大、女性、低BMI、TVR/PegIFN/R和SVR12。Wilcoxon秩和检验显示SMV/PegIFN/R和TVR/PegIFN/R之间的总MRU相关成本相当。
据我们所知，本研究首次描述了CHC治疗经验丰富的患者中，常见的MRU相关成本预测因素之间的关系及其对总MRU相关成本的联合影响。所确定的MRU相关成本预测因素表明，在疾病进展之前尽早开始治疗可避免显著的治疗成本。此外，不良事件似乎是治疗选择时需要考虑的最重要因素，尤其是当治疗方案的医疗资源利用水平和相关成本相似时。
