Department of Public Health Science and Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi, Korea.
J Gastroenterol Hepatol. 2019 Apr;34(4):776-783. doi: 10.1111/jgh.14554. Epub 2018 Dec 25.
For genotype 2 chronic hepatitis C (CHC), the efficacy and safety of sofosbuvir plus ribavirin therapy (SOF + RBV) was better than pegylated interferon plus ribavirin therapy (PR) at a greater drug cost. This study investigated the cost-effectiveness of SOF + RBV compared with PR for treatment-naïve genotype 2 CHC in South Korea.
Using a decision analytic Markov model, a cost-effectiveness analysis comparing SOF + RBV with PR or no treatment for treatment-naïve genotype 2 CHC was performed with probabilistic and deterministic sensitivity analyses from the payer's perspective in 2017. Three cohorts of patients aged 40-49, 50-59, and 60-69 years were simulated to progress through the fibrosis stages F0-F4 to end-stage liver disease, hepatocellular carcinoma, or death. Published and calculated data on the clinical efficacy of the regimen, health-related quality of life, costs, and transition probabilities were used.
While the incremental cost-effectiveness ratio for PR was dominant over no treatment, the incremental cost-effectiveness ratios for SOF + RBV were $20 058 for the patients in their 40s, $19 662 for those in their 50s, and $22 278 for those in their 60s compared with PR. Probabilistic sensitivity analysis indicated an 89.0% probability for the SOF + RBV to be cost-effective at a willingness to pay of $29 754.4 (per-capita gross domestic product in 2017) for the patients in their 40s and 94.1% and 89.1% for the patients in their 50s and 60s, respectively.
The SOF + RBV is a cost-effective option for genotype 2 treatment-naïve CHC patients, especially for the patients with liver cirrhosis in Korea.
对于基因型 2 慢性丙型肝炎（CHC），与聚乙二醇干扰素加利巴韦林治疗（PR）相比，索磷布韦加利巴韦林治疗（SOF+RBV）的疗效和安全性更好，但药物费用更高。本研究旨在从支付者的角度，评估韩国初治基因型 2 CHC 患者中 SOF+RBV 与 PR 或无治疗相比的成本效益。
采用决策分析马尔可夫模型，从支付者的角度，对初治基因型 2 CHC 患者中 SOF+RBV 与 PR 或无治疗进行成本效益分析，概率和确定性敏感性分析在 2017 年进行。模拟了年龄在 40-49 岁、50-59 岁和 60-69 岁的三个患者队列，通过纤维化阶段 F0-F4 进展至终末期肝病、肝细胞癌或死亡。使用方案的临床疗效、健康相关生活质量、成本和转移概率的已发表和计算数据。
PR 的增量成本效益比明显优于无治疗，但 SOF+RBV 的增量成本效益比对于 40 多岁的患者为 20058 美元，50 多岁的患者为 19662 美元，60 多岁的患者为 22278 美元，与 PR 相比。概率敏感性分析表明，对于 40 多岁的患者，SOF+RBV 在支付意愿为 29754.4 美元（2017 年人均国内生产总值）时具有 89.0%的成本效益概率，对于 50 多岁和 60 多岁的患者分别为 94.1%和 89.1%。
SOF+RBV 是韩国基因型 2 初治 CHC 患者的一种具有成本效益的选择，尤其是对于肝硬化患者。
