香港基因 1 型慢性丙型肝炎病毒感染患者全口服直接抗病毒治疗方案的成本-效用分析。
Cost-Utility of All-Oral Direct-Acting Antiviral Regimens for the Treatment of Genotype 1 Chronic Hepatitis C Virus-Infected Patients in Hong Kong.
机构信息
Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.
State Key Laboratory of Liver Disease, The University of Hong Kong, Pok Fu Lam, Hong Kong.
出版信息
Dig Dis Sci. 2021 Apr;66(4):1315-1326. doi: 10.1007/s10620-020-06281-8. Epub 2020 May 8.
BACKGROUND
Direct-acting antivirals (DAAs) are entering the hepatitis C virus (HCV) treatment landscape in Hong Kong, prompting the need for cost-effectiveness evaluations of these interventions to enable optimal use of healthcare resources.
AIMS
This study aimed to compare the cost-effectiveness of DAAs to standard-of-care pegylated interferon plus ribavirin (RBV) in treatment-naïve patients without significant liver fibrosis and to compare different DAAs in patients who are treatment-experienced and/or have advanced liver disease.
METHODS
A Markov model was constructed to evaluate cost-effectiveness over a lifetime time horizon from the payer perspective. The target population was treatment-naïve and treatment-experienced HCV genotype 1 patients, stratified by degree of liver fibrosis. The model consists of 16 health states encompassing METAVIR fibrosis score (F0-F4), treatment success or failure, decompensated cirrhosis, hepatocellular carcinoma, liver transplant, and liver-related death. The proportions of patients achieving sustained virologic response were obtained from clinical trials. Other inputs were obtained from published and local data. The primary outcome was incremental cost-utility ratio for each DAA versus pegylated interferon + ribavirin and among different DAAs.
RESULTS
In treatment-naïve F0-2 HCV patients, all DAAs were cost-effective in genotype 1a and daclatasvir + asunaprevir, elbasvir/grazoprevir, ledipasvir/sofosbuvir, and glecaprevir/pibrentasvir were cost-effective compared to pegylated interferon + ribavirin in genotype 1b. In genotypes 1a and 1b, treatment-experienced patients, and F3-4 patients, elbasvir/grazoprevir was the least costly DAA and economically dominant over most other DAAs.
CONCLUSIONS
DAAs can be a cost-effective option for the treatment of genotype 1 HCV patients in Hong Kong, and elbasvir/grazoprevir is cost-effective.
背景
直接作用抗病毒药物（DAAs）正在进入香港的丙型肝炎病毒（HCV）治疗领域，这促使我们需要对这些干预措施进行成本效益评估，以优化医疗资源的利用。
目的
本研究旨在比较直接作用抗病毒药物与标准护理聚乙二醇干扰素加利巴韦林（RBV）在无明显纤维化的初治患者中的成本效益，并比较不同直接作用抗病毒药物在治疗经验丰富和/或有进展性肝病的患者中的疗效。
方法
从支付者的角度，构建一个马尔可夫模型来评估终生的成本效益。目标人群为初治和治疗经验丰富的 HCV 基因型 1 患者，按肝纤维化程度分层。该模型由 16 个健康状态组成，包括 METAVIR 纤维化评分（F0-F4）、治疗成功或失败、失代偿性肝硬化、肝细胞癌、肝移植和与肝脏相关的死亡。从临床试验中获得患者获得持续病毒学应答的比例。其他投入数据来自已发表和本地数据。主要结果是每种直接作用抗病毒药物与聚乙二醇干扰素加利巴韦林相比的增量成本效益比，以及不同直接作用抗病毒药物之间的成本效益比。
结果
在初治 F0-2 HCV 患者中，所有直接作用抗病毒药物在基因型 1a 和 daclatasvir+asunaprevir、elbasvir/grazoprevir、ledipasvir/sofosbuvir 和 glecaprevir/pibrentasvir 中均具有成本效益，而在基因型 1b 中，与聚乙二醇干扰素加利巴韦林相比，这些药物具有成本效益。在基因型 1a 和 1b、治疗经验丰富的患者和 F3-4 患者中，elbasvir/grazoprevir 是最便宜的直接作用抗病毒药物，在大多数其他直接作用抗病毒药物中具有经济优势。
结论
直接作用抗病毒药物可作为香港 HCV 基因型 1 患者的一种具有成本效益的治疗选择，elbasvir/grazoprevir 具有成本效益。
Zotero 插件