School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region of China.
Department of Infectious Disease, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Clin Microbiol Infect. 2022 Feb;28(2):300.e1-300.e8. doi: 10.1016/j.cmi.2021.06.024. Epub 2021 Jun 28.
Hepatitis B virus infection is an important public health problem. We analysed the cost-effectiveness of the first-line therapies, including nucleotide analogues (namely tenofovir alafenamide fumarate (TAF), tenofovir disoproxil fumarate (TDF) and entecavir) and pegylated interferon (Peg-IFN) for patients with chronic hepatitis B (CHB) in China.
A Markov model describing CHB disease progression was constructed to compare the cost-effectiveness of the first-line therapies, considering both satisfactory (HBeAg seroconversion) and optimal (HBsAg seroclearance) treatment goals. We examined the main outcomes, including cumulative lifetime cost per patient, incremental quality-adjusted life years (QALYs), incremental cost-effectiveness ratio and net monetary benefit. Uncertainty analysis was conducted to identify key influential parameters.
Compared with the baseline strategy, Peg-IFN had the highest QALY gain for HBeAg-positive (HBeAg+) CHB patients achieving a satisfactory goal and an optimal goal (3.19 and 6.32 respectively), and TDF was the most cost-effective therapy for HBeAg-negative CHB patients ($1418/QALY) achieving a satisfactory goal. Among nucleotide analogues, TAF was the most-effective strategy and had higher acceptability to achieve an optimal goal in the Eastern region of China (under 1 x GDP per capita threshold).
Among nucleotide analogues, TDF was the most cost-effective treatment in China for CHB patients to achieve satisfactory and optimal treatment goals, whereas TAF was cost-effective and more effective in the wealthier region. Peg-IFN was most cost-effective among HBeAg+ CHB patients to achieve both goals, with better clinical outcomes. Our findings also indicate the importance of regular monitoring during and after CHB treatment, and could inform treatment strategies in China and other countries.
乙型肝炎病毒感染是一个重要的公共卫生问题。我们分析了包括核苷酸类似物（即富马酸替诺福韦艾拉酚胺（TAF）、富马酸替诺福韦二吡呋酯（TDF）和恩替卡韦）和聚乙二醇干扰素（Peg-IFN）在内的一线治疗方案在我国慢性乙型肝炎（CHB）患者中的成本效益。
构建了一个描述 CHB 疾病进展的 Markov 模型，以比较包括满意（HBeAg 血清学转换）和最佳（HBsAg 血清学清除）治疗目标在内的一线治疗方案的成本效益。我们检查了主要结局，包括每个患者的累积终生成本、增量质量调整生命年（QALYs）、增量成本效益比和净货币收益。进行不确定性分析以确定关键的影响参数。
与基线策略相比，Peg-IFN 使 HBeAg 阳性（HBeAg+）CHB 患者达到满意目标和最佳目标时获得了最高的 QALY 增益（分别为 3.19 和 6.32），而 TDF 是使 HBeAg 阴性 CHB 患者达到满意目标时最具成本效益的治疗方法（每 QALY 成本为 1418 美元）。在核苷酸类似物中，TAF 是最有效的策略，在中国东部地区达到最佳目标的可接受性更高（低于人均国内生产总值 1 倍的阈值）。
在中国，对于 CHB 患者达到满意和最佳治疗目标，TDF 是核苷酸类似物中最具成本效益的治疗方法，而 TAF 在更富裕的地区则具有成本效益和更高的疗效。Peg-IFN 是达到这两个目标的 HBeAg+CHB 患者中最具成本效益的治疗方法，具有更好的临床结局。我们的研究结果还表明，在 CHB 治疗期间和之后进行定期监测非常重要，这可以为中国和其他国家的治疗策略提供信息。
