Institute of Economic Policy, Università Cattolica del Sacro Cuore, Milan, Italy; Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy.
Graduate School of Health Economics and Management, Università Cattolica del Sacro Cuore, Rome, Italy.
Value Health. 2018 Jul;21(7):783-791. doi: 10.1016/j.jval.2017.10.021. Epub 2017 Dec 6.
To conduct a cost-effectiveness analysis of two planning strategies of the second-generation direct-acting antiviral interferon-free regimens for the treatment of chronic hepatitis C virus infection.
A lifetime multicohort model comprised 8125 real-life patients enrolled in the PITER (Italian platform for the study of viral hepatitis) registry, implemented by the ISS (Istituto Superiore di Sanità). Two treatment planning strategies were compared: 1) policy 1-treat all patients regardless of the stage of fibrosis (F0-F4) with second-generation direct-acting antivirals and 2) policy 2-treat patients at F3/F4 stage and those who are prioritized by the scientific guidelines first, and the remaining patients when they reach the F3 stage. Clinical outcomes and costs were evaluated by using a lifetime horizon Markov model and adopting the third-party payer perspective. Health outcomes were expressed in terms of quality-adjusted life-years (QALYs). A sensitivity analysis was run to explore first- and second-order uncertainty and heterogeneity. An expected value of perfect information analysis was also conducted.
Policy 1 exhibits an incremental cost-effectiveness ratio of €8,775/QALY gained and remains less than €30,000/QALY in 94% of realizations produced by the Monte-Carlo simulation. Such a proportion increases to 97% when adopting a threshold of €40,000/QALY gained.
Moving from the urgency criterion to evidence-based escalating strategies when prioritizing the access to new anti-hepatitis C virus treatments is a good investment in health, whose affordability should be explored through context-specific budget impact analyses.
对第二代直接作用抗病毒无干扰素方案治疗慢性丙型肝炎病毒感染的两种规划策略进行成本效果分析。
一个由 8125 名真实患者组成的终生多队列模型纳入了由意大利国家卫生研究所（ISS）实施的 PITER（意大利病毒性肝炎研究平台）注册研究，该模型采用终生马尔可夫模型，并采用第三方支付者的视角来评估临床结果和成本。使用两种治疗规划策略进行比较：1）策略 1-无论纤维化（F0-F4）阶段如何，都用第二代直接作用抗病毒药物治疗所有患者；2）策略 2-仅治疗 F3/F4 阶段的患者和那些首先按照科学指南进行优先排序的患者，其余患者在达到 F3 阶段时进行治疗。健康结果以质量调整生命年（QALY）表示。进行敏感性分析以探索一阶和二阶不确定性和异质性。还进行了完全信息期望价值分析。
策略 1 的增量成本效果比为 8775 欧元/QALY，在蒙特卡罗模拟产生的 94%的实现中仍低于 30000 欧元/QALY。当采用 40000 欧元/QALY 的收益阈值时，这一比例增加到 97%。
从紧急情况标准转向基于证据的逐步升级策略，优先考虑获得新的抗丙型肝炎病毒治疗方法是一项对健康的良好投资，应通过特定于上下文的预算影响分析来探讨其负担能力。
