对美国所有乙型肝炎阳性个体进行治疗的成本效益分析。

Cost-effectiveness of treating all hepatitis B-positive individuals in the United States.

机构信息

Center for Disease Analysis Foundation, Lafayette, Colorado, USA.

出版信息

J Viral Hepat. 2023 Sep;30(9):718-726. doi: 10.1111/jvh.13843. Epub 2023 Jun 1.

Abstract

Chronic hepatitis B virus (HBV) infection is a leading cause of liver disease and related mortality globally. However, most of the infected individuals in the United States remain undiagnosed and untreated. There is a need to understand more completely the economic and disease burden impact of removing treatment restrictions and increasing diagnosis and treatment. The PRoGReSs model, a dynamic HBV model that tracks the infected population by year, disease stage, and gender, was used to quantify the disease and economic burden of chronic HBV infection in the United States from 2020 to 2050 based on four scenarios: a status quo (base) scenario and three treat-all scenarios, in which screening, diagnosis, and treatment were maximized at different annual treatment price levels of $5382, $2000 and $750. Compared to the base scenario, the treat-all scenarios would avert 71,100 acute and 11,100 chronic incident cases of HBV, and 169,000 liver-related deaths from 2020 to 2050. At an annual treatment cost of $2000, treating all HBV infections would be highly cost-effective, and at $750 would be cost saving and would achieve a positive return on investment before 2050. Maximizing the diagnosed and treated HBV population in the United States would avert a significant number of cases of advanced liver disease and related mortality. Such interventions can also be cost-effective compared to the status quo strategy, and cost saving at a treatment price threshold of $750 annually, above the current lowest annual treatment cost of $362.

摘要

慢性乙型肝炎病毒 (HBV) 感染是全球导致肝病和相关死亡的主要原因。然而,美国大多数感染个体仍未被诊断和治疗。我们需要更全面地了解消除治疗限制、增加诊断和治疗的经济和疾病负担的影响。PRoGReSs 模型是一种动态 HBV 模型,通过年份、疾病阶段和性别跟踪感染人群,根据四种情况(现状(基础)情景和三种治疗所有情景),从 2020 年到 2050 年,在美国使用 PRoGReSs 模型量化慢性 HBV 感染的疾病和经济负担,在不同的年度治疗价格水平(5382 美元、2000 美元和 750 美元)下最大限度地进行筛查、诊断和治疗。与基础情景相比,治疗所有情景将避免 71100 例急性和 11100 例慢性乙型肝炎新发病例,以及 2020 年至 2050 年 169000 例与肝脏相关的死亡。在每年 2000 美元的治疗费用下,治疗所有 HBV 感染将具有高度成本效益,而每年 750 美元的治疗费用将具有成本效益,并将在 2050 年前实现正投资回报。最大限度地增加美国被诊断和治疗的 HBV 人群将避免大量的晚期肝病和相关死亡病例。与现状策略相比,这些干预措施也具有成本效益,并且在每年 750 美元的治疗价格门槛下具有成本效益,高于目前每年 362 美元的最低治疗费用。

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