Kaishima Terumi, Akita Tomoyuki, Ohisa Masayuki, Sakamune Kazuaki, Kurisu Akemi, Sugiyama Aya, Aikata Hiroshi, Chayama Kazuaki, Tanaka Junko
Department of Epidemiology, Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Hepatol Res. 2018 Jun;48(7):509-520. doi: 10.1111/hepr.13053. Epub 2018 Feb 17.
We estimated the cost-effectiveness of direct-acting antiviral treatment (DAA) compared to triple therapy (simeprevir, pegylated interferon-α [Peg-IFN], and ribavirin [RBV]) (scenario 1), Peg-IFN + RBV (scenario 2), and non-antiviral therapy (scenario 3).
Cost-effectiveness was evaluated as incremental cost-effectiveness ratios (ICERs) using direct costs and indirect costs, which included loss of wages during the patient's lifetime due to early death caused by viral hepatitis infection. Quality of life (QOL) scores were determined by EQ-5D-3L questionnaire survey on 200 HCV patients in Hiroshima.
The QOL scores for chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma were estimated as 0.871, 0.774, and 0.780, respectively. The follow-up period that the ICER of scenario 1 becomes shortest (cost <¥6 million) was 25 years after treatment in men and women who started treatment at the age of 20-60. In contrast, those of scenarios 2 and 3 was 10 years after treatment in patients who started treatment at age <80 years. Based on the sensitivity analysis in scenario 1, the most significant factor affecting the value of ICER is the QOL score after sustained virologic response (SVR), followed by the SVR rate of DAA or follow-up period.
Direct-acting antiviral treatment was estimated to be cost-effective from 10 to 25 years after treatment, depending on the SVR rate of the drugs and the age of onset of treatment. In order to increase the cost-effectiveness of DAA treatment, measures or effort to improve the QOL score of patients after SVR are necessary.
我们评估了直接抗病毒治疗（DAA）与三联疗法（simeprevir、聚乙二醇化干扰素-α [Peg-IFN] 和利巴韦林 [RBV]）（方案1）、Peg-IFN + RBV（方案2）以及非抗病毒治疗（方案3）相比的成本效益。
使用直接成本和间接成本，以增量成本效益比（ICER）评估成本效益，间接成本包括因病毒性肝炎感染导致的过早死亡造成的患者一生中的工资损失。通过对广岛200例丙型肝炎病毒（HCV）患者进行EQ-5D-3L问卷调查来确定生活质量（QOL）评分。
慢性肝炎、肝硬化和肝细胞癌的QOL评分分别估计为0.871、0.774和0.780。方案1的ICER变为最短（成本<600万日元）的随访期，对于20 - 60岁开始治疗的男性和女性为治疗后25年。相比之下，方案2和方案3的随访期为<80岁开始治疗的患者治疗后10年。基于方案1中的敏感性分析，影响ICER值的最显著因素是持续病毒学应答（SVR）后的QOL评分，其次是DAA的SVR率或随访期。
根据药物的SVR率和治疗起始年龄，直接抗病毒治疗在治疗后10至25年被估计具有成本效益。为了提高DAA治疗的成本效益，有必要采取措施或努力提高患者SVR后的QOL评分。
