Turnes Juan, Domínguez-Hernández Raquel, Casado Miguel Ángel
Complejo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, Pontevedra, España.
Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, España.
Gastroenterol Hepatol. 2017 Aug-Sep;40(7):433-446. doi: 10.1016/j.gastrohep.2017.05.004. Epub 2017 Jun 21.
To evaluate the cost-effectiveness of a strategy based on direct-acting antivirals (DAAs) following the marketing of simeprevir and sofosbuvir (post-DAA) versus a pre-direct-acting antiviral strategy (pre-DAA) in patients with chronic hepatitis C, from the perspective of the Spanish National Health System.
A decision tree combined with a Markov model was used to estimate the direct health costs (€, 2016) and health outcomes (quality-adjusted life years, QALYs) throughout the patient's life, with an annual discount rate of 3%. The sustained virological response, percentage of patients treated or not treated in each strategy, clinical characteristics of the patients, annual likelihood of transition, costs of treating and managing the disease, and utilities were obtained from the literature. The cost-effectiveness analysis was expressed as an incremental cost-effectiveness ratio (incremental cost per QALY gained). A deterministic sensitivity analysis and a probabilistic sensitivity analysis were performed.
The post-DAA strategy showed higher health costs per patient (€30,944 vs. €23,707) than the pre-DAA strategy. However, it was associated with an increase of QALYs gained (15.79 vs. 12.83), showing an incremental cost-effectiveness ratio of €2,439 per QALY. The deterministic sensitivity analysis and the probabilistic sensitivity analysis showed the robustness of the results, with the post-DAA strategy being cost-effective in 99% of cases compared to the pre-DAA strategy.
Compared to the pre-DAA strategy, the post-DAA strategy is efficient for the treatment of chronic hepatitis C in Spain, resulting in a much lower cost per QALY than the efficiency threshold used in Spain (€30,000 per QALY).
从西班牙国家卫生系统的角度，评估在simeprevir和索磷布韦上市后基于直接抗病毒药物（DAAs）的策略（DAA后策略）与直接抗病毒药物前策略（DAA前策略）相比，用于慢性丙型肝炎患者的成本效益。
采用决策树与马尔可夫模型相结合的方法，估计患者一生中的直接医疗成本（欧元，2016年）和健康结局（质量调整生命年，QALYs），年贴现率为3%。持续病毒学应答、每种策略中接受治疗或未接受治疗的患者百分比、患者的临床特征、年度转移可能性、疾病治疗和管理成本以及效用均来自文献。成本效益分析以增量成本效益比（每获得一个QALY的增量成本）表示。进行了确定性敏感性分析和概率敏感性分析。
DAA后策略显示每位患者的医疗成本（30,944欧元对23,707欧元）高于DAA前策略。然而，它与获得的QALYs增加相关（15.79对12.83），显示每QALY的增量成本效益比为2,439欧元。确定性敏感性分析和概率敏感性分析显示结果具有稳健性，与DAA前策略相比，DAA后策略在99%的情况下具有成本效益。
与DAA前策略相比，DAA后策略在西班牙治疗慢性丙型肝炎方面是有效的，导致每QALY的成本远低于西班牙使用的效率阈值（每QALY 30,000欧元）。
