Department of Clinical Pharmacy, Shenyang Pharmaceutical University, Shenyang, China.
Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Clin Drug Investig. 2018 May;38(5):427-437. doi: 10.1007/s40261-018-0621-9.
Daclatasvir plus asunaprevir has shown superior efficacy and safety for treating hepatitis C virus genotype 1b infection in comparison with pegylated interferon and ribavirin. The objective of this analysis is to investigate the cost effectiveness of daclatasvir plus asunaprevir compared with interferon-α-based therapies from the perspective of the Chinese healthcare system.
A Markov model was established to measure economic and health outcomes of daclatasvir plus asunaprevir compared with general interferon-α plus ribavirin and pegylated interferon plus ribavirin for hepatitis C virus genotype 1b infection. We also considered the two following scenarios: 24 weeks of daclatasvir plus asunaprevir used as a second-line treatment for ineligible/intolerant and non-responding patients with HCV during 48 weeks of first-line interferon-α plus ribavirin (interferon-α plus ribavirin and daclatasvir plus asunaprevir) or pegylated interferon plus ribavirin (pegylated interferon plus ribavirin and daclatasvir plus asunaprevir) treatment. Clinical costs and utility inputs were derived from the published literature. The incremental cost-effectiveness ratio was shown as costs in US dollars per quality-adjusted life-years gained. Uncertainty was examined by one-way and probabilistic sensitivity analyses.
Compared with interferon-α plus ribavirin, pegylated interferon and ribavirin, interferon-α plus ribavirin plus daclatasvir plus asunaprevir, and pegylated interferon plus ribavirin plus daclatasvir plus asunaprevir strategies, daclatasvir plus asunaprevir gained an additional 0.62, 0.32, 0.20, and 0.15 quality-adjusted life-year with increasing costs of US$11,950, US$671, US$8366, and -$3783, respectively. The incremental cost-effectiveness ratios of pegylated interferon and ribavirin, daclatasvir plus asunaprevir, interferon-α plus ribavirin and daclatasvir plus asunaprevir, and pegylated interferon plus ribavirin and daclatasvir plus asunaprevir against the baseline interferon-α plus ribavirin strategy were US$37,930, US$19,233, US$8495, and US$33,031 per quality-adjusted life-year gained. Daclatasvir plus asunaprevir and interferon-α plus ribavirin plus daclatasvir plus asunaprevir were presented as the cost-effective alternatives, and pegylated interferon plus ribavirin and pegylated interferon plus ribavirin and daclatasvir plus asunaprevir strategies dominated. The model outputs were sensitive to a patient's age, discount rate, and the risk ratio between pegylated interferon plus ribavirin and interferon-α plus ribavirin.
Daclatasvir plus asunaprevir in the Chinese setting is likely to be cost effective for treating hepatitis C virus genotype 1b infection.
达卡他韦联合asunaprevir 治疗丙型肝炎病毒 1b 型感染的疗效和安全性优于聚乙二醇干扰素联合利巴韦林。本分析的目的是从中国医疗体系的角度探讨达卡他韦联合asunaprevir 与基于干扰素-α的治疗方案相比的成本效益。
建立了一个马尔可夫模型，以衡量达卡他韦联合asunaprevir 与普通干扰素-α联合利巴韦林和聚乙二醇干扰素联合利巴韦林治疗丙型肝炎病毒 1b 型感染的经济和健康结果。我们还考虑了以下两种情况：在使用普通干扰素-α联合利巴韦林治疗 48 周的基础上，将 24 周的达卡他韦联合asunaprevir 作为二线治疗方案用于不耐受/不耐受和无应答的丙型肝炎病毒患者（干扰素-α联合利巴韦林和达卡他韦联合asunaprevir）或聚乙二醇干扰素联合利巴韦林（聚乙二醇干扰素联合利巴韦林和达卡他韦联合asunaprevir）治疗。临床成本和效用投入来自已发表的文献。增量成本效益比以每获得一个质量调整生命年的成本（美元）表示。通过单因素和概率敏感性分析来检验不确定性。
与干扰素-α联合利巴韦林、聚乙二醇干扰素联合利巴韦林、干扰素-α联合利巴韦林联合达卡他韦联合asunaprevir 和聚乙二醇干扰素联合利巴韦林联合达卡他韦联合asunaprevir 相比，达卡他韦联合asunaprevir 分别增加了 0.62、0.32、0.20 和 0.15 个质量调整生命年，成本分别增加了 11950 美元、671 美元、8366 美元和-3783 美元。聚乙二醇干扰素联合利巴韦林、达卡他韦联合asunaprevir、干扰素-α联合利巴韦林联合达卡他韦联合asunaprevir 和聚乙二醇干扰素联合利巴韦林联合达卡他韦联合asunaprevir 相对于基础干扰素-α联合利巴韦林方案的增量成本效益比分别为每获得一个质量调整生命年的 37930 美元、19233 美元、8495 美元和 33031 美元。达卡他韦联合asunaprevir 和干扰素-α联合利巴韦林联合达卡他韦联合asunaprevir 被认为是具有成本效益的替代方案，而聚乙二醇干扰素联合利巴韦林和聚乙二醇干扰素联合利巴韦林联合达卡他韦联合asunaprevir 方案则具有优势。模型结果对患者年龄、贴现率和聚乙二醇干扰素联合利巴韦林与干扰素-α联合利巴韦林的风险比敏感。
达卡他韦联合asunaprevir 在中国治疗丙型肝炎病毒 1b 型感染可能具有成本效益。
