College of Pharmacy, Ajou University, Suwon, Gyeonggi-do, Republic of Korea.
Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.
Hepatol Int. 2022 Apr;16(2):294-305. doi: 10.1007/s12072-022-10310-1. Epub 2022 Mar 24.
Due to stringent reimbursement criteria, significant numbers of patients with compensated cirrhosis (CC) and low-level viremia [LLV; serum hepatitis B virus (HBV)-DNA levels of 20-2000 IU/mL] remain untreated especially in the East Asian countries, despite potential risk of disease progression. We analyzed cost-effectiveness to assess rationales for antiviral therapy (AVT) for this population.
We compared cost and effectiveness (quality-adjusted life years, QALYs) in a virtual cohort including 10,000 54-year-old CC-LLV patients receiving AVT (Scenario I) versus no treatment (Scenario II). A Markov model, including seven HBV-related conditions, was used. Values for transition probabilities and costs were mostly obtained from recent real-world South Korean data.
As per a simulation of a base-case analysis, AVT reduced costs by $639 USD and yielded 0.108 QALYs per patient for 5 years among CC-LLV patients compared to no treatment. Thus, AVT is a cost-saving option with lower costs and better effectiveness than no treatment. If 10,000 patients received AVT, 815 incident cases of hepatocellular carcinoma (HCC) and 630 HBV-related deaths could be averted in 5 years compared to no treatment. In case of 10-year observation, AVT was consistently dominant. Even when the transition probabilities from CC-LLV vs. maintained virological response to HCC were same, fluctuation of results also lied within willingness-to-pay in South Korea. In the probabilistic sensitivity analysis with the willingness-to-pay threshold, the probability of AVT cost-effectiveness was 100%.
The extended application of AVT in CC-LLV patients may contribute positively to individual clinical benefits and national healthcare budgets.
由于报销标准严格，许多代偿性肝硬化（CC）和低病毒载量（LLV；血清乙型肝炎病毒 [HBV]-DNA 水平为 20-2000 IU/mL）患者未得到治疗，尤其是在东亚国家，尽管存在疾病进展的潜在风险。我们分析了成本效益，以评估对该人群进行抗病毒治疗（AVT）的合理性。
我们在一个包括 10000 名 54 岁 CC-LLV 患者的虚拟队列中比较了成本和效果（质量调整生命年，QALYs），这些患者接受了 AVT（方案 I）与未治疗（方案 II）。使用了一个包括七种与 HBV 相关的疾病的 Markov 模型。转移概率和成本的值主要来自最近的韩国真实世界数据。
根据基础案例分析的模拟结果，与未治疗相比，AVT 可降低每位患者 5 年的成本 639 美元，并使 CC-LLV 患者的 QALY 增加 0.108。因此，AVT 是一种具有成本效益的选择，其成本低于未治疗，效果优于未治疗。如果有 10000 名患者接受 AVT，与未治疗相比，在 5 年内可避免 815 例肝癌（HCC）和 630 例 HBV 相关死亡。在 10 年观察期内，AVT 始终占主导地位。即使 CC-LLV 与维持病毒学应答至 HCC 的转移概率相同，结果的波动也在韩国的支付意愿范围内。在支付意愿阈值的概率敏感性分析中，AVT 的成本效益概率为 100%。
在 CC-LLV 患者中扩大应用 AVT 可能对个体临床获益和国家医疗保健预算产生积极影响。
