建立在中国的全国乙肝治疗方案

StephenW

Global Health, Health Policy, Infectious Disease, Research, Stanford News
Building the case for a national hepatitis B treatment program in China
Rachel Leslie on November 4th, 2015 No Comments

Building the case for a national hepatitis B treatment program in China

An estimated 100 million people in China are living with chronic hepatitis B infection, making it the most prevalent life threatening disease in the country. If left untreated, hepatitis B can lead to serious liver damage and is the leading cause of liver-related cancer and deaths in China. Despite the availability of effective therapies, there is no national policy in place to cover hepatitis B treatment and many patients, particularly those with rural health plans, can’t afford it.

Now, in the first comprehensive, independent study of its kind, researchers at Stanford and the University of Michigan have published a cost-effective analysis of all available treatments – branded and generic – for chronic hepatitis B in China. The analysis, published today in PLOS ONE, quantifies the economic value and potential life-saving benefits of implementing a national treatment strategy in China.

"If China can successfully treat hepatitis B, the rest of the world will follow"

The paper is also the first to provide cost thresholds, meaning the specific price point at which a particular drug would be cost-effective or offer cost-savings.

“Health insurance programs in China don’t always cover the most effective medications,” said Stanford research associate Mehlika Toy, PhD, lead author of the study. “In comparing the potential cost-effectiveness of all available treatments, we aim to provide policy-makers in China with the evidence to support the development and implementation of a viral hepatitis treatment program, and information to help support drug pricing negotiations.”

In their analysis, the researchers compared eight different treatment strategies using a statistical model to simulate disease progression and long-term health outcomes. The analysis evaluated chronic hepatitis B patients who had not received prior treatment, but would be eligible for treatment under current international and World Health Organization guidelines.

Costs were determined based on estimated medical management and related costs associated with disease complications, such as cirrhosis (scarring of the liver) and liver cancer, as well as generic and brand drug costs.

The findings showed that certain therapies performed better than others and that not treating at all resulted in the highest health care costs and the worst health outcomes, compared to other strategies. For example, it was shown that 65 percent of non-cirrhotic patients with active hepatitis associated with high virus concentrations (HBeAg positive) would die of hepatitis B-related liver disease in their lifetime if not treated. Alternately, approximately 60 percent of those deaths could be averted if treated with one of two highly potent, low-resistance drugs, entecavir and tenofovir.

Treatment with entecavir or tenofovir was shown to significantly avert hepatitis B-related mortality and liver cancer across all treatment groups and resulted in 5.5 to 12.1 quality adjusted life years (QALYs), a measure of disease burden based on healthy years of life gained.

“These QALY gains are impressive, since few treatments for chronic non-communicable diseases or chronic infectious diseases result in such a gain in healthy life years,” the authors wrote.

Despite the significant gains in health outcomes, under the current drug pricing in China, entecavir and tenofovir remain out of reach for most patients and are often not prescribed as the first-line therapy. But implementation of a national treatment strategy could potentially change that.

Branded tenofovir is available to the Chinese public-health system for the treatment of HIV/AIDS at the cost of less than $30 per month, but the price of the same medication to treat hepatitis B is more than 8 times higher at $240 per month. If China were to adopt a national treatment program, it could mean higher bargaining power with drug manufacturers and potentially result in significant cost savings.

Building a case for a national hepatitis B treatment strategy in China is strengthened considering that China accounts for almost half of the global burden of disease and accounts for nearly 400,000 hepatitis B-related deaths per year. And, at a time when the WHO is calling all nations to get on board with a Global Hepatitis Action Plan, the modeling used in this study could be adapted for other high endemic countries seeking to develop national treatment programs.

“We think China can be a model for the world, not only in hepatitis B newborn vaccination, which they have done really well, but in treatment of chronic hepatitis B,” Samuel So, MD, director of the Stanford Asian Liver Center and senior author of the study, told me. “If China can successfully treat hepatitis B, the rest of the world will follow.”

Rachel Leslie is the communications officer at Stanford’s Center for Innovation in Global Health.
- See more at: http://scopeblog.stanford.edu/20 ... thash.r5dQiznp.dpuf

StephenW

全球卫生，卫生政策，传染病，研究，斯坦福大学新闻
建立的情况下在中国的全国乙肝治疗方案
雷切尔张国荣在2015年11月4日没有评论

建立的情况下在中国的全国乙肝治疗方案

据估计，有1亿人在中国生活的慢性乙肝病毒感染，使之成为最普遍的威胁生命的疾病在国家。如果不进行治疗，乙型肝炎可导致严重的肝损伤，并且是肝相关癌症和在中国人死亡的主要原因。尽管有效的治疗方法的有效性，有在地方覆盖乙肝的治疗，许多患者，特别是那些农村健康计划，买不起的国家政策。

现在，在同类产品中第一个全面，独立的研究中，研究人员在斯坦福大学和密歇根大学发表的所有可用的治疗具有成本效益的分析 - 品牌和通用的 - 在中国慢性乙型肝炎。经分析，今天在PLoS ONE发表的，量化的经济价值和在中国实施国民待遇的战略潜力挽救生命的益处。

“如果中国能够成功地治疗乙肝，世界的其余部分将遵循”

本文也是最早提供的成本阈值，这意味着具体的价格点上，特定的药物将具有成本效益或提供节省成本。

“在中国的健康保险计划并不总是覆盖最有效的药物，”斯坦福大学的研究助理Mehlika玩具，博士，研究的主要作者。 “在比较了所有可用的治疗方法的潜在成本效益，我们的目标是提供决策者在中国的证据支持制定和实施病毒性肝炎治疗方案，以及信息，以帮助支持药品定价的谈判。”

在他们的分析中，研究人员比较了八个不同的治疗策略使用统计模型来模拟疾病进展和长期健康后果。该分析评估并没有接受过谁的治疗的慢性乙肝患者，但在当前国际和世界卫生组织的指导方针将有资格接受治疗。

成本的基础上估计的医疗管理和与疾病相关的并发症的相关费用，如肝硬化（肝脏疤痕）和肝癌，以及通用的和品牌药物费用进行了测定。

研究结果显示，某些治疗方法比别人表现得更好，而不是治疗都产生最高的医疗费用和最差的健康状况，相对于其他策略。例如，已显示，65％的非肝硬化患者的高病毒浓度（HBeAg阳性）相关联的活动性肝炎将死的乙型肝炎相关的肝脏疾病在其一生中如果不治疗。或者，如果与两个高度有效的，低电阻的药物，恩替卡韦和替诺福韦1处理约60％的人死亡的可能被避免。

治疗恩替卡韦或替诺福韦被证明显著避免乙型肝炎相关的死亡率和肝癌在所有治疗组中，并导致5.5至12.1质量调整生命年（QALY而言），疾病负担的基础上健康寿命年获得的量度。

“这些QALY收益是可观的，因为很少有治疗慢性非传染性疾病和慢性感染性疾病导致的健康生命年这样的收益，”作者写道。

尽管显著收益卫生成果，在中国目前的药品定价下，恩替卡韦和替诺福韦保持了对大多数患者体验，而且往往没有规定作为一线治疗。但是，实施国民待遇策略可能会改变这种状况。

品牌替诺福韦是提供给艾滋病毒/艾滋病在少于$ 30元每月的费用的处理，中国的公共卫生系统，但同样的药物来治疗乙肝的价格为$ 240人不等每月超过8倍。如果中国采取国民待遇的程序，它可以与药商意味着更高的议价能力，并可能导致显著的成本节约。

建设案例在中国全国乙肝治疗策略得到加强考虑，中国占全球疾病负担的近一半，占每年近40万乙肝相关死亡。而且，在当世卫组织呼吁各国在船上得到了全球肝炎行动计划一段时间，在此研究中使用的模型可以适用于其他高流行国家努力制定本国的治疗方案。

“我们认为中国可能是一个典范的世界，不仅在乙肝新生儿疫苗接种，他们已经做得非常好，但在治疗慢性乙肝，”塞缪尔所以，医学博士，斯坦福大学亚裔肝脏中心和高级主任该研究报告的作者，告诉我的。 “如果中国能够成功地治疗乙肝，在世界其他国家也会跟进。”

瑞秋张国荣是通信官斯坦福大学的创新中心在全球卫生。
- 在查看更多： http://scopeblog.stanford.edu/20 ... thash.r5dQiznp.dpuf

ivanich

中国人死亡的主要原因……看到这里不想看下去了，很有站台的悬疑。

MP4

广州门特恩替卡韦报销后实际支付131元人民币每月
不报销的也不高于300RMB

MP4

经济困难的可以申请免费长效干扰素
正版替诺要1472RMB，但是现在有TAF临床试验免费的