Universidade de São Paulo, Faculdade de Medicina, Departamento de Gastroenterologia, São Paulo, SP, Brasil.
Arq Gastroenterol. 2022 Apr-Jun;59(2):268-274. doi: 10.1590/S0004-2803.202202000-48.
Hepatorenal syndrome (HRS) is the most severe form of acute kidney injury in patients with advanced cirrhosis, and it is associated with high mortality. It is usually diagnosed according to criteria defined by the International Ascites Club. Currently, the most frequently indicated pharmacological therapy for the treatment of HRS is a combination of splanchnic vasoconstrictors (terlipressin or norepinephrine) in combination with albumin. With the progressive increase in healthcare spending, it is important to conduct a cost-effectiveness analysis of pharmacological treatment in patients who are diagnosed with HRS.
To perform a cost-effectiveness assessment for the use of terlipressin in combination with albumin to treat HRS in patients with cirrhosis.
Economic evaluation of cost-effectiveness based on secondary data from studies showed the efficacy of terlipressin therapy compared with norepinephrine combined with albumin or albumin alone. The cost-effectiveness analysis was calculated using an incremental cost-effectiveness ratio (ICER), and a sensitivity analysis was developed by varying the values of therapies and probabilities. The Brazilian real was the currency used in the analysis, and the results were converted to US dollars.
After selection, eligibility, and evaluation of the quality of publications, the results demonstrated that administration of terlipressin or norepinephrine in combination with albumin in patients diagnosed with HRS type 1 was efficacious. The cost of treatment with terlipressin in combination with albumin was USD $1,644.06, administration of albumin alone was USD $912.02, and norepinephrine plus albumin was USD $2,310.78. Considering that the combination therapies demonstrated effectiveness, the incremental cost of terlipressin and norepinephrine in combination with albumin was USD $666.73, and an effectiveness of 0.570 was found for terlipressin in combination with albumin and 0.200 for norepinephrine in combination with albumin. The incremental effectiveness was 0.370, and the ICER was USD $1,801.97. Thus, the parameters of increasing cost per therapy and ICER indicated that the combined therapy of terlipressin plus albumin was cost effective compared to albumin alone or norepinephrine plus albumin in a public single-payer healthcare system.
A cost-effectiveness analysis showed that terlipressin in combination with albumin when administered concomitantly to patients who were diagnosed with type 1 HRS is cost-effective compared to norepinephrine in combination with albumin administered in a controlled environment.
肝肾综合征（HRS）是晚期肝硬化患者急性肾损伤最严重的形式，死亡率很高。它通常根据国际腹水俱乐部定义的标准进行诊断。目前，治疗 HRS 最常用的药物治疗方法是将内脏血管收缩剂（特利加压素或去甲肾上腺素）与白蛋白联合使用。随着医疗保健支出的不断增加，对诊断为 HRS 的患者进行药物治疗的成本效益分析非常重要。
对肝硬化患者使用特利加压素联合白蛋白治疗 HRS 的成本效益进行评估。
根据特利加压素治疗效果的二次数据进行经济评估，与去甲肾上腺素联合白蛋白或白蛋白单独治疗进行比较。通过增量成本效益比（ICER）计算成本效益分析，并通过改变治疗方法和概率值进行敏感性分析。巴西雷亚尔是分析中使用的货币，结果转换为美元。
经过选择、合格性和出版物质量评估，结果表明，特利加压素或去甲肾上腺素联合白蛋白治疗 HRS 1 型患者是有效的。特利加压素联合白蛋白治疗的费用为 1644.06 美元，白蛋白单独治疗的费用为 912.02 美元，去甲肾上腺素联合白蛋白的费用为 2310.78 美元。考虑到联合治疗方法有效，特利加压素和去甲肾上腺素联合白蛋白的增量成本为 666.73 美元，特利加压素联合白蛋白的有效性为 0.570，去甲肾上腺素联合白蛋白的有效性为 0.200。增量有效性为 0.370，ICER 为 1801.97 美元。因此，每个治疗方案的增量成本和 ICER 参数表明，与白蛋白单独治疗或去甲肾上腺素联合白蛋白治疗相比，特利加压素联合白蛋白的联合治疗在公共单一支付医疗保健系统中具有成本效益。
成本效益分析表明，与在受控环境中给予去甲肾上腺素联合白蛋白相比，特利加压素联合白蛋白同时给予诊断为 1 型 HRS 的患者具有成本效益。
