恩替卡韦治疗对中国慢性乙型肝炎长期死亡率，发病率和保

StephenW

Value Health Reg Issues. 2013 May;2(1):48-56. doi: 10.1016/j.vhri.2013.02.002. Epub 2013 Apr 30.
A Novel Estimation of the Impact of Treatment with Entecavir on Long-Term Mortality, Morbidity, and Health Care Costs of Chronic Hepatitis B in China.
Wei L1, Hu S2, Hou J3, Liu G4, Ren H5, Duan Z6, Xie Q7, Fang X8, Jia J9.
Author information

1
    Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China.
2
    School of Public Health, Fudan University, Shanghai, China.
3
    Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
4
    Guanghua School of Management, Peking University, Beijing, China.
5
    Infectious Diseases, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
6
    Artificial Liver Center, Beijing You'an Hospital, Capital Medical University, Beijing, China.
7
    Infectious Diseases, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.
8
    Monitor Deloitte China, Shanghai, China.
9
    Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China. Electronic address: [email protected].

Abstract
OBJECTIVES:

Health care decision makers are increasingly concerned about the value of chronic hepatitis B (CHB) treatments in China. This analysis aims at estimating the relative value of entecavir as a first-line option at treatment initiation and for different treatment durations from a holistic perspective.
METHODS:

CHB was simulated by using a Markov disease transition model with disease states based on available natural history data. The model assumed 5-year treatment duration with entecavir, lamivudine, telbivudine, and adefovir based on published clinical data. The speed of disease progression varies by viral load and hepatitis B "e" antigen status. Direct medical costs included medication and management of liver complications. The primary output was the estimated cost savings of entecavir per patient per day versus the comparator.
RESULTS:

For treatment duration of 5 years and a follow-up period of 30 years, entecavir treatment was translated into specific patient benefit of an estimated cost saving of $2.69 per day compared with no treatment. In addition, long-term usage of entecavir resulted in daily $2.33 and $1.73 cost saving compared with short-term usage (1-year and 2-year, respectively). Among available treatment options in China, entecavir treatment exhibited about $0.90 to $1.81 daily cost saving versus the comparators. The detailed daily cost saving of entecavir is summarized as follows-entecavir versus lamivudine: $1.81, entecavir versus telbivudine: $0.90, entecavir versus adefovir: $2.02, and entecavir versus generic adefovir: $1.37.
CONCLUSIONS:

Long-term usage of entecavir exhibits the characteristics of a favorable CHB treatment, which translates into economic value as opposed to either no treatment or alternative strategies.

Copyright © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
KEYWORDS:

adefovir; chronic hepatitis B; cost benefit; entecavir; lamivudine; telbivudine

PMID:
    29702852
DOI:
    10.1016/j.vhri.2013.02.002

StephenW

价值健康注册问题。 2013年5月; 2（1）：48-56。 doi：10.1016 / j.vhri.2013.02.002。电子杂志2013年4月30日。
恩替卡韦治疗对中国慢性乙型肝炎长期死亡率，发病率和保健费用影响的新评估。
Wei L1，Hu S2，Hou J3，Liu G4，Ren H5，Duan Z6，Xie Q7，Fang X8，Jia J9。
作者信息

1
    北京大学人民医院，北京大学肝病研究所，中国北京。
2
    复旦大学公共卫生学院，中国上海。
3
    南方医科大学南方医院感染科，广东广州。
4
    北京大学光华管理学院，北京，中国。
五
    重庆医科大学附属第二医院感染科，重庆，中国。
6
    首都医科大学附属北京佑安医院人工肝中心，北京。
7
    上海交通大学附属瑞金医院感染科，上海，中国。
8
    德勤中国，上海，中国。
9
    首都医科大学附属北京友谊医院肝脏研究中心，北京，中国。电子地址：[email protected]。

抽象
目的：

卫生保健决策者越来越关注中国慢性乙型肝炎（CHB）治疗的价值。该分析旨在从整体角度评估恩替卡韦作为治疗开始时的一线选择和不同治疗持续时间的相对价值。
方法：

根据可用的自然史数据，通过使用具有疾病状态的马尔可病疾病转变模型来模拟CHB。根据公布的临床数据，该模型假定恩替卡韦，拉米夫定，替比夫定和阿德福韦酯的治疗持续时间为5年。疾病进展的速度因病毒载量和乙型肝炎“e”抗原状态而异。直接医疗费用包括药物治疗和肝脏并发症的处理。主要产出是恩替卡韦每名患者每天相对于比较者的估计成本节约。
结果：

对于5年的治疗持续时间和30年的随访期，恩替卡韦治疗被转化为特定的患者益处，与未治疗相比，估计每天节省费用2.69美元。此外，与短期使用（分别为1年和2年）相比，长期使用恩替卡韦导致每日节省2.33美元和1.73美元的费用。在中国可用的治疗方案中，恩替卡韦治疗与比较药物相比，每日节约费用约为0.90美元至1.81美元。恩替卡韦的每日成本节约总结如下：恩替卡韦与拉米夫定：1.81美元，恩替卡韦与替比夫定：0.90美元，恩替卡韦与阿德福韦：2.02美元，恩替卡韦与通用阿德福韦：1.37美元。
结论：

恩替卡韦的长期使用表现出有利CHB治疗的特征，这转化为经济价值而不是不治疗或替代策略。

版权所有©2013国际药物经济与结果研究学会（ISPOR）。由Elsevier Inc.出版。保留所有权利。
关键词：

阿德福韦;慢性乙型肝炎;成本效益;恩替卡韦;拉米夫定;替比夫定

结论：
    29702852
DOI：
    10.1016 / j.vhri.2013.02.002