Buti M, Casado M A, Fosbrook L, Esteban R
Servicio de Hepatología, Hospital General Universitario de la Vall d'Hebron, Barcelona.
Gastroenterol Hepatol. 1998 Apr;21(4):161-8.
The purpose of this study was to assess the cost-effectiveness of the treatment of chronic hepatitis C with interferon in Spain. Disease progression was studied using a Markov model through which an untreated cohort of 1000 patients was compared with cohorts treated with interferon 3 MU three times per week for 6, 12 or 18 months. Treatment cost, patients quality of life, and survival were the parameters evaluated. Using the perspective of the National Health System, an 18 month treatment with alfa interferon offers a better cost-effectiveness ratio than a treatment of 6 or 12 months duration. The age of the patient at the start of treatment is one of the most influential factors on the cost-effectiveness of treatment. In patients under 45 years of age, a net cost saving is observed with all treatment schedules, especially with 18 months treatment, due to significant reductions in severe complications of disease progression. In patients aged 45-60, 18 months treatment incurs a net cost, although important gains are made in survival and quality of life. In patients over 65 years of age, the economic benefits of prolonged treatment do not compensate the extra cost. In conclusion, treatment of chronic hepatitis C with alfa interferon should begin as early as possible, especially in young patients. In cases of favourable response, treatment should be extended to 18 months, in order to obtain a higher rate of sustained response, avoid progression of hepatic disease and achieve a more favourable cost-effectiveness ratio.
本研究的目的是评估在西班牙使用干扰素治疗慢性丙型肝炎的成本效益。通过马尔可夫模型研究疾病进展，将1000名未经治疗的患者队列与接受每周三次3MU干扰素治疗6、12或18个月的队列进行比较。评估的参数包括治疗成本、患者生活质量和生存率。从国家卫生系统的角度来看，使用α干扰素进行18个月的治疗比6个月或12个月的治疗具有更好的成本效益比。治疗开始时患者的年龄是影响治疗成本效益的最主要因素之一。在45岁以下的患者中，所有治疗方案都能实现净成本节约，尤其是18个月的治疗，这是由于疾病进展的严重并发症显著减少。在45 - 60岁的患者中，18个月的治疗会产生净成本，尽管在生存率和生活质量方面有重要改善。在65岁以上的患者中，延长治疗的经济效益无法弥补额外成本。总之，使用α干扰素治疗慢性丙型肝炎应尽早开始，尤其是在年轻患者中。在反应良好的情况下，治疗应延长至18个月，以便获得更高的持续反应率，避免肝病进展并实现更有利的成本效益比。
