Vargas Constanza L, Espinoza Manuel A, Giglio Andrés, Soza Alejandro
Centre of Clinical Research, Health Technology Assessment Unit, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Department of Public Health, Pontificia Universidad Catolica de Chile, Santiago, Chile.
PLoS One. 2015 Nov 6;10(11):e0141660. doi: 10.1371/journal.pone.0141660. eCollection 2015.
Daclatasvir and Asunaprevir (DCV/ASV) have recently been approved for the treatment of chronic hepatitis C virus infection. In association, they are more effective and safer than previous available treatments, but more expensive. It is unclear if paying for the additional costs is an efficient strategy considering limited resources.
A Markov model was built to estimate the expected costs in Chilean pesos (CL$) and converted to US dollars (US$) and benefits in quality adjusted life years (QALYs) in a hypothetic cohort of naive patients receiving DCV/ASV compared to protease inhibitors (PIs) and Peginterferon plus Ribavirin (PR). Efficacy was obtained from a mixed-treatment comparison study and costs were estimated from local sources. Utilities were obtained applying the EQ-5D survey to local patients and then valued with the Chilean tariff. A time horizon of 46 years and a discount rate of 3% for costs and outcomes was considered. The ICERs were estimated for a range of DCV/ASV prices. Deterministic and probabilistic sensitivity analyses were performed.
PIs were extendedly dominated by DCV/ASV. The ICER of DCV/ASV compared to PR was US$ 16,635/QALY at a total treatment price of US$ 77,419; US$11,581 /QALY at a price of US$ 58,065; US$ 6,375/QALY at a price of US$ 38,710; and US$ 1,364 /QALY at a price of US$ 19,355. The probability of cost-effectiveness at a price of US$ 38,710 was 91.6% while there is a 21.43% probability that DCV/ASV dominates PR if the total treatment price was US$ 19,355. Although the results are sensitive to certain parameters, the ICER did not increase above the suggested threshold of 1 GDP per capita.
DCV/ASV can be considered cost-effective at any price of the range studied. These results provide decision makers useful information about the value of incorporating these drugs into the public Chilean healthcare system.
达卡他韦和阿舒瑞韦（DCV/ASV）最近已被批准用于治疗慢性丙型肝炎病毒感染。联合使用时，它们比以前可用的治疗方法更有效、更安全，但成本更高。考虑到资源有限，支付额外费用是否是一种有效的策略尚不清楚。
构建了一个马尔可夫模型，以估计智利比索（CL$）的预期成本，并转换为美元（US$），以及在接受DCV/ASV的初治患者假设队列中与蛋白酶抑制剂（PIs）和聚乙二醇干扰素加利巴韦林（PR）相比的质量调整生命年（QALYs）收益。疗效来自一项混合治疗比较研究，成本从当地来源估计。通过对当地患者应用EQ-5D调查获得效用，然后根据智利关税进行估值。考虑了46年的时间范围和3%的成本及结果贴现率。对一系列DCV/ASV价格估计了增量成本效果比（ICER）。进行了确定性和概率敏感性分析。
DCV/ASV在很大程度上优于PIs。与PR相比，DCV/ASV的ICER在总治疗价格为77,419美元时为16,635美元/QALY；在价格为58,065美元时为11,581美元/QALY；在价格为38,710美元时为6,375美元/QALY；在价格为19,355美元时为1,364美元/QALY。在价格为38,710美元时具有成本效益的概率为91.6%，而如果总治疗价格为19,355美元，DCV/ASV优于PR的概率为21.43%。尽管结果对某些参数敏感，但ICER并未超过建议的人均1国内生产总值的阈值。
在所研究的任何价格范围内，DCV/ASV都可被视为具有成本效益。这些结果为决策者提供了有关将这些药物纳入智利公共医疗保健系统的价值的有用信息。
