From the Department of VIP, Shanghai Children's Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Pediatr Infect Dis J. 2020 Jun;39(6):e59-e65. doi: 10.1097/INF.0000000000002717.
Novel oral regimes have been approved for treating hepatitis C virus (HCV) infection in adolescents due to their superior effectiveness and safety. However, its economic outcome is still unclear in this population. The current analysis investigates the cost-effectiveness of novel oral regimens compared with that of pegylated interferon α with ribavirin (PR) therapies in adolescents in the context of the United States and China.
A Markov model was developed to measure the economic and health outcomes of ledipasvir/sofosbuvir (LS) for genotypes 1 and 4, sofosbuvir/ribavirin (SR) for genotype 2, and ledipasvir/sofosbuvir/ribavirin (LSR) for genotype 3 HCV infection compared with the outcomes of PR treatment. Clinical costs and utility inputs were gathered from published sources. Lifetime discounted quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) were measured. The uncertainty was facilitated by 1-way and probabilistic sensitivity analyses.
In the United States, the ICERs of LS strategy were $14,699 and $14,946/QALY for genotypes 1 and 4 HCV infection, respectively; the ICER of SR strategy for genotype 2 was $42,472/QALY; and the ICER of LSR for genotype 3 was $49,409/QALY in comparison with the PR strategy. In Chinese adolescents, LS for genotypes 1 and 4, SR for genotype 2, and LSR for genotype 3 were the dominant alternatives to the PR strategy. The results were robust to sensitivity analyses.
Novel oral regimes for adolescents with HCV infection are likely to be cost-effective in the context of the United States and China.
新型口服药物已被批准用于治疗青少年丙型肝炎病毒 (HCV) 感染，因其具有更好的疗效和安全性。然而，其在该人群中的经济结果尚不清楚。本分析研究了新型口服药物与聚乙二醇干扰素 α 联合利巴韦林 (PR) 治疗方案在美中两国青少年中的成本效益。
采用 Markov 模型来衡量索磷布韦/维帕他韦 (LS) 治疗 1 型和 4 型、索磷布韦/利巴韦林 (SR) 治疗 2 型和索磷布韦/维帕他韦/利巴韦林 (LSR) 治疗 3 型 HCV 感染的经济和健康结果，并与 PR 治疗的结果进行比较。临床成本和效用输入来自已发表的来源。测量了终身贴现质量调整生命年 (QALY)、成本和增量成本效益比 (ICER)。通过单因素和概率敏感性分析来促进不确定性。
在美国，LS 治疗方案治疗 1 型和 4 型 HCV 感染的 ICER 分别为 14699 美元和 14946 美元/QALY；SR 治疗方案治疗 2 型 HCV 感染的 ICER 为 42472 美元/QALY；LSR 治疗方案治疗 3 型 HCV 感染的 ICER 为 49409 美元/QALY，与 PR 治疗方案相比。在中国青少年中，LS 治疗 1 型和 4 型、SR 治疗 2 型和 LSR 治疗 3 型是 PR 治疗方案的主要替代方案。结果对敏感性分析具有稳健性。
在美中两国，新型口服药物治疗青少年 HCV 感染可能具有成本效益。
