Prison Health Program. Institut Català de La Salut. Barcelona. Spain.
Pharmacoeconomics & Outcomes Research Iberia (PORIB). Madrid. Spain.
Rev Esp Sanid Penit. 2020 May-Aug;22(2):66-74. doi: 10.18176/resp.00012. Epub 2020 Jul 20.
To evaluate the cost-effectiveness of direct-acting antiviral (DAAs) treatment versus non-treatment in prisoners awaiting treatment for chronic hepatitis C (CHC) and to analyse the clinical and economic impact of the treatment on liver complications and mortality.
A lifetime Markov model was developed to simulate treatment and disease progression from an estimated cohort of 4,408 CHC prisoners treated with DAAs over 2 years (50% of patient each year) versus no treatment. In the treated cohort, a sustained viral response of 95% was associated. Patient characteristics, transition probabilities, utilities and costs (pharmacological and healthcare states) were obtained from published literature. The model estimated healthcare costs and benefits, incremental cost-utility ratio (ICUR) based on total costs and the quality-adjusted life year (QALY) and avoided clinical events. A National Healthcare System perspective was adopted with a 3% annual discount rate for both costs and health outcomes. Sensitivity analyses were performed to assess uncertainty.
In the DDA treated cohort, the model estimated a decrease of 92% of decompensated cirrhosis and 83% of hepatocellular carcinoma, 88% liver-related mortality cases were reduced, 132 liver transplants were avoided. The treatment achieved an additional 5.0/QALYs (21.2 vs. 16.2) with an incremental cost of €3,473 (€24,088 vs. €20,615) per patient with an ICUR of €690 per QALY gained.
Considering the willingness-to-pay threshold used in Spain (€22,000-30,000/QALY), DAAs treatment for prisoners with CHC is a highly cost-effective strategy, reduces infection transmission, increases survival and reduces complications due to liver disease, as well as the cost associated with its management.
评估直接作用抗病毒药物 (DAAs) 治疗与不治疗慢性丙型肝炎 (CHC) 待治囚犯的成本效益，并分析治疗对肝脏并发症和死亡率的临床和经济影响。
开发了一个终身马尔可夫模型，以模拟从估计的 4408 名接受 DAA 治疗的 CHC 囚犯队列（每年 50%的患者）与不治疗的情况下治疗和疾病进展。在治疗队列中，假设持续病毒学应答率为 95%。患者特征、转移概率、效用和成本（药物和医疗保健状态）均来自已发表的文献。该模型估计了医疗保健成本和效益、基于总成本和质量调整生命年（QALY）的增量成本效益比（ICUR）以及避免的临床事件。采用国家医疗保健系统视角，对成本和健康结果均采用 3%的年贴现率。进行了敏感性分析以评估不确定性。
在 DAA 治疗队列中，模型估计代偿性肝硬化和肝细胞癌分别减少了 92%和 83%，减少了 88%的与肝脏相关的死亡病例，避免了 132 例肝移植。治疗可额外获得 5.0 个 QALYs（21.2 比 16.2），每个患者的增量成本为 3473 欧元（24088 欧元比 20615 欧元），增量成本效益比为 690 欧元/QALY。
考虑到西班牙使用的意愿支付阈值（22000-30000 欧元/QALY），DAA 治疗 CHC 囚犯是一种具有高度成本效益的策略，可降低感染传播，提高生存率，减少肝脏疾病相关并发症，以及相关管理成本。
