Almadiyeva Alima, Ibrayev Serik, Turgambayeva Assiya, Kostyuk Alexandr, Khismetova Zayituna, Akhmetova Zhanar
Dept. of Public Health, Astana Medical University, Astana, Kazakhstan.
National Center for Medicines, Medical Devices and Medical Equipment Expertise, Astana, Kazakhstan.
Iran J Public Health. 2018 Dec;47(12):1845-1853.
The triple therapy including peginterferon, ribavirin and protease inhibitors was more effective compared to the combination of only peginterferon and ribavirin. This study aimed to assess the cost-effectiveness of triple treatment in either treatment-naïve and treatment-experienced patients in Kazakhstan.
A Markov model was created to assess long-term clinical advantages and the cost-effectiveness of the triple therapy from Kazakhstan payer perspective. Health state transition probabilities, pharmaceutical and other costs (according to the price in 2015), and utility rate were acquired from the published studies and publicly available sources. All used costs and benefits were discounted at 5% per year.
Despite treatment background, the patients, receiving boceprevir and telaprevir, were estimated to experience less serious liver-disease complications, more life-years, and more QALYs compared to the patients having standard of care. For treatment-experienced group, boceprevir and telaprevir were dominant, with more QALYs. For all the groups of patients, incremental costs per QALY gained were between USD14995 and USD18075. The total average cost of boceprevir is slightly more costly than a standard duration of treatment with telaprevir, and so is the average cost per SVR. Extensive sensitivity analyses verified robust model results.
The inclusion of protease inhibitors to standard management for the therapy of patients with genotype 1 chronic HCV infection in Kazakhstan is predicted to be cost-effective using a typically applied willingness to pay threshold of USD37805 (3 times GDP per capita).
与仅使用聚乙二醇干扰素和利巴韦林的联合疗法相比，聚乙二醇干扰素、利巴韦林和蛋白酶抑制剂的三联疗法更有效。本研究旨在评估哈萨克斯坦初治和经治患者三联治疗的成本效益。
建立马尔可夫模型，从哈萨克斯坦支付方的角度评估三联疗法的长期临床优势和成本效益。健康状态转换概率、药品及其他成本（根据2015年价格）和效用率来自已发表的研究和公开可用的来源。所有使用的成本和效益均按每年5%进行贴现。
无论治疗背景如何，与接受标准治疗的患者相比，接受博赛匹韦和特拉匹韦治疗的患者预计出现的严重肝病并发症更少，生命年更多，质量调整生命年更多。对于经治组，博赛匹韦和特拉匹韦具有优势，质量调整生命年更多。对于所有患者组，每获得一个质量调整生命年的增量成本在14995美元至18075美元之间。博赛匹韦的总平均成本比特拉匹韦标准治疗疗程略高，每获得持续病毒学应答的平均成本也是如此。广泛的敏感性分析验证了模型结果的稳健性。
在哈萨克斯坦，对于1型慢性丙型肝炎病毒感染患者，在标准治疗中加入蛋白酶抑制剂预计使用通常应用的支付意愿阈值37805美元（人均国内生产总值的3倍）具有成本效益。
