贝叶斯方法在慢性乙型肝炎抗病毒治疗成本效益分析中的应用
Application of Bayesian Approach to Cost-Effectiveness Analysis of Antiviral Treatments in Chronic Hepatitis B.
作者信息
Zhang Hua, Huo Mingdong, Chao Jianqian, Liu Pei
机构信息
Department of Medical Insurance, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China.
出版信息
PLoS One. 2016 Aug 30;11(8):e0161936. doi: 10.1371/journal.pone.0161936. eCollection 2016.
BACKGROUND
Hepatitis B virus (HBV) infection is a major problem for public health; timely antiviral treatment can significantly prevent the progression of liver damage from HBV by slowing down or stopping the virus from reproducing. In the study we applied Bayesian approach to cost-effectiveness analysis, using Markov Chain Monte Carlo (MCMC) simulation methods for the relevant evidence input into the model to evaluate cost-effectiveness of entecavir (ETV) and lamivudine (LVD) therapy for chronic hepatitis B (CHB) in Jiangsu, China, thus providing information to the public health system in the CHB therapy.
METHODS
Eight-stage Markov model was developed, a hypothetical cohort of 35-year-old HBeAg-positive patients with CHB was entered into the model. Treatment regimens were LVD100mg daily and ETV 0.5 mg daily. The transition parameters were derived either from systematic reviews of the literature or from previous economic studies. The outcome measures were life-years, quality-adjusted lifeyears (QALYs), and expected costs associated with the treatments and disease progression. For the Bayesian models all the analysis was implemented by using WinBUGS version 1.4.
RESULTS
Expected cost, life expectancy, QALYs decreased with age. Cost-effectiveness increased with age. Expected cost of ETV was less than LVD, while life expectancy and QALYs were higher than that of LVD, ETV strategy was more cost-effective. Costs and benefits of the Monte Carlo simulation were very close to the results of exact form among the group, but standard deviation of each group indicated there was a big difference between individual patients.
CONCLUSIONS
Compared with lamivudine, entecavir is the more cost-effective option. CHB patients should accept antiviral treatment as soon as possible as the lower age the more cost-effective. Monte Carlo simulation obtained costs and effectiveness distribution, indicate our Markov model is of good robustness.
背景
乙型肝炎病毒（HBV）感染是一个重大的公共卫生问题；及时进行抗病毒治疗可通过减缓或阻止病毒复制，显著预防HBV导致的肝损伤进展。在本研究中，我们应用贝叶斯方法进行成本效益分析，使用马尔可夫链蒙特卡罗（MCMC）模拟方法将相关证据输入模型，以评估在中国江苏恩替卡韦（ETV）和拉米夫定（LVD）治疗慢性乙型肝炎（CHB）的成本效益，从而为CHB治疗的公共卫生系统提供信息。
方法
建立八阶段马尔可夫模型，将一组假设的35岁HBeAg阳性CHB患者纳入模型。治疗方案为每日服用100mg LVD和每日服用0.5mg ETV。转移参数来自文献的系统评价或先前的经济学研究。结果指标为生命年、质量调整生命年（QALY）以及与治疗和疾病进展相关的预期成本。对于贝叶斯模型，所有分析均使用WinBUGS 1.4版进行。
结果
预期成本、预期寿命、QALY随年龄增长而降低。成本效益随年龄增长而增加。ETV的预期成本低于LVD，而预期寿命和QALY高于LVD，ETV策略更具成本效益。蒙特卡罗模拟的成本和效益在组间非常接近精确形式的结果，但每组的标准差表明个体患者之间存在很大差异。
结论
与拉米夫定相比，恩替卡韦是更具成本效益的选择。CHB患者应尽早接受抗病毒治疗，年龄越低成本效益越高。蒙特卡罗模拟获得了成本和效果分布，表明我们的马尔可夫模型具有良好的稳健性。
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