Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Mueang Phitsanulok, Thailand.
Clinical Trial and Evidence-Based Synthesis Research Cluster , Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand.
Appl Health Econ Health Policy. 2022 Jul;20(4):587-596. doi: 10.1007/s40258-022-00719-y. Epub 2022 Feb 10.
Nucleos(t)ide analogues (NAs) are the main drug category used in the treatment of chronic hepatitis B (CHB). There is a need to update the economic evaluation of CHB treatment.
This study aimed to determine the cost effectiveness of NAs for CHB in Thailand.
We used a lifetime Markov model undertaken from a societal perspective. Tenofovir disoproxil fumarate (TDF), tenofovir alafenamide fumarate (TAF), entecavir (ETV) with TDF or TAF as rescue medications, and lamivudine (LAM) with TDF or TAF rescue medications were compared with best supportive care (BSC). We performed a network meta-analysis to estimate the treatment effects of each NA on hepatitis B surface antigen (HBsAg) loss in an Asian population and performed an additional literature review to identify inputs. We calculated incremental cost-effectiveness ratios (ICERs) per quality-adjusted life-years (QALYs) and performed sensitivity analyses.
Compared with BSC, all NAs could improve patients' QALYs, with results ranging from 4.04 to 4.25 QALYs gained. TAF, TDF, LAM/TAF, and LAM/TDF yielded lower total lifetime costs than BSC, ranging from - $US1387 to - 814, whereas ETV/TAF and ETV/TDF yielded higher total lifetime costs than BSC, ranging from $US4965 to 4971. The ICER was $US1230/QALY for ETV/TDF and $US1228/QALY for ETV/TAF. Full incremental analysis showed that the ICER for LAM/TAF was $US1720/QALY compared with TAF.
At current prices, TAF, TDF, LAM/TAF, and LAM/TDF are dominant options, and ETV/TAF or ETV/TDF are cost-effective options. LAM/TAF is the most cost-effective option, followed by TAF.
核苷酸类似物（NAs）是治疗慢性乙型肝炎（CHB）的主要药物类别。需要更新 CHB 治疗的经济评估。
本研究旨在确定 NAs 治疗泰国 CHB 的成本效益。
我们使用了一种从社会角度出发的终生马尔可夫模型。替诺福韦二吡呋酯（TDF）、替诺福韦艾拉酚胺富马酸盐（TAF）、恩替卡韦（ETV）联合 TDF 或 TAF 作为挽救药物，以及拉米夫定（LAM）联合 TDF 或 TAF 挽救药物与最佳支持治疗（BSC）进行比较。我们进行了一项网络荟萃分析，以估计每种 NA 在亚洲人群中对乙型肝炎表面抗原（HBsAg）丧失的治疗效果，并进行了额外的文献回顾以确定投入。我们计算了每质量调整生命年（QALY）的增量成本效益比（ICER），并进行了敏感性分析。
与 BSC 相比，所有 NAs 都可以提高患者的 QALYs，结果范围为 4.04 至 4.25 个 QALYs 增加。TAF、TDF、LAM/TAF 和 LAM/TDF 的总终身成本低于 BSC，范围为-1387 至-814 美元，而 ETV/TAF 和 ETV/TDF 的总终身成本高于 BSC，范围为 4965 至 4971 美元。ETV/TDF 的 ICER 为 1230 美元/QALY，ETV/TAF 的 ICER 为 1228 美元/QALY。全增量分析显示，LAM/TAF 相对于 TAF 的 ICER 为 1720 美元/QALY。
在当前价格下，TAF、TDF、LAM/TAF 和 LAM/TDF 是优势选择，而 ETV/TAF 或 ETV/TDF 是具有成本效益的选择。LAM/TAF 是最具成本效益的选择，其次是 TAF。
