Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California, USA.
Department of Health Management and Policy, University of Michigan, Ann Harbor, MI, USA.
Liver Int. 2022 Jan;42(1):16-25. doi: 10.1111/liv.15027. Epub 2021 Aug 8.
BACKGROUND & AIMS: We aim to capture the economic impact of a potential cure for chronic hepatitis B infection (CHB) in three countries (USA, China and Australia) with different health systems and epidemics to estimate the threshold drug prices below which a CHB cure would be cost-saving and/or highly cost-effective.
We simulated patients' hepatitis B progression, under three scenarios: current long-term suppressive antiviral therapy, functional cure defined as sustained undetectable HBsAg and HBV DNA, and partial cure defined as sustained undetectable HBV DNA only after a finite, 48-week treatment.
Compared with current long-term antiviral therapy, a 30% effective functional cure among patients with and without cirrhosis in the USA, China and Australia would yield 17.50, 17.32 and 20.42 QALYs per patient, and 20.61, 20.42 and 20.62 QALYs per patient respectively. In financial terms, for CHB patients with and without cirrhosis, this would be cost-saving at a one-time treatment cost under US$11 944 and US$6694, respectively, in the USA, US$1744 and US$1001 in China, and US$12 063 and US$10 983 in Australia.
We show that in purely economic terms, a CHB cure will be highly cost-effective even if effective in only 30% of treated patients. The threshold price for cure is largely determined by the current antiviral drug costs, since it will replace a daily antiviral pill that is inexpensive and effective, although not curative. The likely need for combination therapies to achieve cure will also present cost challenges. While cost-effectiveness is important, it cannot be the only consideration, as cure will provide many benefits in addition to reduced liver disease and HCC, including eliminating the need for a long-term daily pill and reducing stigma often associated with chronic viral infection.
我们旨在捕捉慢性乙型肝炎（CHB）感染潜在治愈方法在三个具有不同卫生系统和流行情况的国家（美国、中国和澳大利亚）的经济影响，以估计乙型肝炎治愈药物的价格阈值，低于该阈值时，乙型肝炎治愈将具有成本效益和/或高度成本效益。
我们模拟了三种情况下患者的乙型肝炎进展情况：当前长期抑制性抗病毒治疗、定义为持续不可检测 HBsAg 和 HBV DNA 的功能性治愈以及定义为仅在有限的 48 周治疗后持续不可检测 HBV DNA 的部分治愈。
与当前长期抗病毒治疗相比，在美国、中国和澳大利亚有或无肝硬化的患者中，30%有效的功能性治愈将使每位患者获得 17.50、17.32 和 20.42 个质量调整生命年（QALY），以及 20.61、20.42 和 20.62 个质量调整生命年（QALY）。从经济角度来看，对于有或无肝硬化的 CHB 患者，在美国，一次性治疗费用低于 11944 美元和 6694 美元，在中国，一次性治疗费用低于 1744 美元和 1001 美元，以及在澳大利亚，一次性治疗费用低于 12063 美元和 10983 美元时，这种治疗将具有成本效益。
我们表明，从纯粹的经济角度来看，即使仅在 30%的治疗患者中有效，乙型肝炎治愈也将具有高度成本效益。治愈的价格阈值在很大程度上取决于当前的抗病毒药物成本，因为它将替代一种廉价且有效的每日抗病毒药物，尽管无法治愈，但具有成本效益。实现治愈可能需要联合治疗，这也将带来成本挑战。虽然成本效益很重要，但它不能是唯一的考虑因素，因为治愈除了减少肝脏疾病和 HCC 之外，还将提供许多好处，包括消除长期每日服药的需要和减少慢性病毒感染带来的耻辱感。
