Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, L2-08, 2/F Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, 999077, China.
Division of Gastroenterology & Hepatology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, 999077, China.
Eur J Clin Microbiol Infect Dis. 2017 Oct;36(10):1801-1809. doi: 10.1007/s10096-017-2995-7. Epub 2017 May 17.
The purpose of this investigation was to evaluate the budget impact and cost-effectiveness of direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) infection in Hong Kong. A decision analytic model was developed to compare short-term costs and health outcomes of patients with chronic HCV genotype 1 infection in Hong Kong who were treated with an interferon (INF)-based treatment (dual therapy of pegylated interferon and ribavirin) or DAA-based treatments (sofosbuvir or ledipasvir/sofosbuvir or ombitasvir/paritaprevir/ritonavir plus dasabuvir). Compared to INF-based treatment, DAA-based treatments yielded an incremental cost of $24,677-$31,171 per course while improving the rate of sustained virologic response (SVR) from 59-66% to 82.3-99.8%. The incremental cost-effective ratios of DAA-based treatments ranged from $9724 to $29,189 per treatment success, which were all below the cost-effectiveness threshold of local GDP per capita ($42,423 in 2015). Introducing DAAs resulted in a 126.1% ($383.7 million) budget increase on HCV infection management over 5 years. A 50% change in DAA medication costs reflected a change in the incremental budget from $55.2 to $712.3 million. DAA-based treatments are cost-effective alternatives to INF-based treatment in Hong Kong. Introducing DAAs to the public hospital formulary yields a considerable budget increase but is still economically favorable to the local government.
本研究旨在评估直接作用抗病毒药物（DAA）治疗香港丙型肝炎病毒（HCV）感染的预算影响和成本效益。采用决策分析模型比较了香港慢性 HCV 基因 1 型感染患者采用干扰素（INF）为基础的治疗（聚乙二醇干扰素联合利巴韦林的双疗法）或 DAA 为基础的治疗（索非布韦或雷迪帕韦/索非布韦或奥比他韦/帕利他韦/利托那韦联合达沙布韦）的短期成本和健康结果。与基于 INF 的治疗相比，基于 DAA 的治疗每疗程增加成本$24677 至$31171，但 SVR 率从 59-66%提高至 82.3-99.8%。基于 DAA 的治疗的增量成本效益比为每治疗成功$9724 至$29189，均低于当地人均 GDP （2015 年为$42423）的成本效益阈值。引入 DAA 后，5 年内 HCV 感染管理的预算增加了 126.1%（$383.7 百万）。DAA 药物费用降低 50%会使增量预算从$55.2 百万增加至$712.3 百万。在香港，DAA 治疗是 INF 治疗的一种具有成本效益的替代方法。将 DAA 纳入公立医院药物清单会导致预算大幅增加，但对地方政府仍具有经济优势。
