Li Runqin, Lin Xiao, Wang Jing-Yue, Wang Xiaomo, Lu Junfeng, Liu Yali, Cao Zhenhuan, Ren Shan, Ma Lina, Jin Yi, Zheng Sujun, Hu Zhongjie, Wang Li, Chen Xinyue
The First Unit, Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Division of Hepatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
Ann Transl Med. 2021 Sep;9(17):1365. doi: 10.21037/atm-21-1666.
Hepatitis B surface antigen clearance or seroconversion is rarely achieved for patients using nucleoside analogs or pegylated interferon alpha monotherapy approaches. Several recent studies have confirmed the benefit of a combination of these two approaches for selected chronic hepatitis B patients. However, few reports have investigated long-term outcomes or health economic evaluation for hepatitis B surface antigen clearance. The aim of this study was to perform a cost-effectiveness analysis of the long-term use of this combination strategy among selected hepatitis B e antigen-negative patients.
Drawing on experience in China, we used a Markov model to simulate disease progression among a population of hepatitis B e antigen-negative chronic hepatitis B patients with surface antigen levels of ≤1,000 IU/mL through a discrete series of health states. We compared nucleoside analog monotherapy to the combination strategy over a prolonged period. We measured lifetime costs, quality-adjusted life-years and incremental cost-effectiveness ratios.
The combination therapy produced 15.8 quality-adjusted life-years, and cost US dollars (USD) 45,032 per patient. The monotherapy gave 13.9 quality-adjusted life-years, and had a cost of USD 52,064. The incremental cost-effectiveness ratio of the monotherapy (USD -3,755 per quality-adjusted life-year) did not obtain extended dominance over combination therapy. The most cost-effective option was combination therapy among patients with hepatitis B surface antigen levels of ≤10 IU/mL, which had the lowest calculated cost of USD 35,318 and most quality-adjusted life-years (16.7).
A long-term combination treatment strategy for selected hepatitis B e antigen-negative chronic hepatitis B patients may prolong quality-adjusted life-years compared with nucleoside analog monotherapy. Chronic hepatitis B patients with a hepatitis B surface antigen level of ≤10 IU/mL were the most cost-effective population under this strategy.
对于使用核苷类似物或聚乙二醇化干扰素α单一疗法的患者，很少能实现乙肝表面抗原清除或血清学转换。最近的几项研究证实了这两种方法联合使用对部分慢性乙型肝炎患者的益处。然而，很少有报告调查乙肝表面抗原清除的长期结果或卫生经济学评估。本研究的目的是对选定的乙肝e抗原阴性患者长期使用这种联合策略进行成本效益分析。
借鉴中国的经验，我们使用马尔可夫模型，通过一系列离散的健康状态，模拟乙肝e抗原阴性、表面抗原水平≤1000 IU/mL的慢性乙型肝炎患者群体中的疾病进展。我们在较长时期内比较了核苷类似物单一疗法与联合策略。我们测量了终生成本、质量调整生命年和增量成本效益比。
联合治疗产生了15.8个质量调整生命年，每位患者的成本为45,032美元。单一疗法产生了13.9个质量调整生命年，成本为52,064美元。单一疗法的增量成本效益比（每质量调整生命年-3,755美元）并未在联合治疗上获得广泛优势。最具成本效益的选择是乙肝表面抗原水平≤10 IU/mL的患者采用联合治疗，其计算成本最低，为35,318美元，质量调整生命年最多（16.7）。
与核苷类似物单一疗法相比，针对选定的乙肝e抗原阴性慢性乙型肝炎患者的长期联合治疗策略可能会延长质量调整生命年。在该策略下，乙肝表面抗原水平≤10 IU/mL的慢性乙型肝炎患者是最具成本效益的人群。
