成年免疫耐受期慢性乙型肝炎患者抗病毒治疗的成本效益

StephenW

Cost-effectiveness of antiviral treatment in adult patients with immune-tolerant phase chronic hepatitis B
Hye-Lin Kim  1 , Gi-Ae Kim  2 , Jae-A Park  3 , Hye-Rim Kang  3 , Eui-Kyung Lee  4 , Young-Suk Lim  5
Affiliations
Affiliations

    1
    College of Pharmacy, Sahmyook University, Seoul, Republic of Korea.
    2
    Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
    3
    School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea.
    4
    School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea [email protected] [email protected].
    5
    Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea [email protected] [email protected].

    PMID: 33239344 DOI: 10.1136/gutjnl-2020-321309

Abstract

Objective: The cost-effectiveness of antiviral treatment in adult immune-tolerant (IT) phase chronic hepatitis B (CHB) patients is uncertain.

Design: We designed a Markov model to compare expected costs and quality-adjusted life-years (QALYs) of starting antiviral treatment at IT-phase ('treat-IT') vs delaying the therapy until active hepatitis phase ('untreat-IT') in CHB patients over a 20-year horizon. A cohort of 10 000 non-cirrhotic 35-year-old patients in IT-phase CHB (hepatitis B e antigen-positive, mean serum hepatitis B virus (HBV) DNA levels 7.6 log10 IU/mL, and normal alanine aminotransferase levels) was simulated. Input parameters were obtained from previous studies at Asan Medical Center, Korea. The incremental cost-effectiveness ratio (ICER) between the treat-IT and untreat-IT strategies was calculated.

Results: From a healthcare system perspective, the treat-IT strategy with entecavir or tenofovir had an ICER of US$16 516/QALY, with an annual hepatocellular carcinoma (HCC) incidence of 0.73% in the untreat-IT group. With the annual HCC risk ≥0.54%, the treat-IT strategy was cost-effective at a willingness-to-pay threshold of US$20 000/QALY. From a societal perspective considering productivity loss by premature death, the treat-IT strategy was extremely cost-effective, and was dominant (ICER <0) if the HCC risk was ≥0.43%, suggesting that the treat-IT strategy incurs less costs than the untreat-IT strategy. The most influential parameters on cost-effectiveness of the treat-IT strategy were those related with HCC risk (HBV DNA levels, platelet counts and age) and drug cost.

Conclusion: Starting antiviral therapy in IT phase is cost-effective compared with delaying the treatment until the active hepatitis phase in CHB patients, especially with increasing HCC risk, decreasing drug costs and consideration of productivity loss.

Keywords: antiviral therapY; cost-effectiveness; hepatitis B.

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

StephenW

成年免疫耐受期慢性乙型肝炎患者抗病毒治疗的成本效益
金慧琳1，金基爱2，宰宰公园3，姜慧琳3，李义京4，林淑淑5
隶属关系
隶属关系

    1个
    韩国首尔，萨米库克大学药学院。
    2
    韩国首尔庆熙大学医学院内科。
    3
    韩国水原成均馆大学药学院。
    4
    韩国水原成均馆大学药学院[email protected] [email protected]。
    5
    韩国首尔蔚山大学医学院牙山医学中心消化内科[email protected] [email protected]。

    PMID：33239344 DOI：10.1136 / gutjnl-2020-321309

抽象

目的：在成人免疫耐受（IT）期慢性乙型肝炎（CHB）患者中抗病毒治疗的成本效益尚不确定。

设计：我们设计了一个马尔可夫模型，以比较在IT阶段（'IT-IT'）开始抗病毒治疗与将治疗推迟到活动性肝炎阶段（'unreat-IT'）的预期成本和质量调整生命年（QALYs）。 ）超过20年的CHB患者。在IT阶段CHB（乙型肝炎e抗原阳性，平均血清乙型肝炎病毒（HBV）DNA水平为7.6 log10 IU / mL，丙氨酸转氨酶水平正常）的10,000名非肝硬化35岁患者中，模拟。输入参数来自韩国Asan医学中心的先前研究。计算了IT治疗策略和IT治疗策略之间的增量成本效益比（ICER）。

结果：从医疗保健系统的角度来看，恩替卡韦或替诺福韦的IT治疗策略的ICER为16 516美元/ QALY，未治疗IT组的年肝细胞癌（HCC）发生率为0.73％。在每年HCC风险≥0.54％的情况下，treat-IT策略具有成本效益，支付意愿阈值为20000 / QALY。从社会角度考虑过早死亡造成的生产力损失，IT治疗策略具有极高的成本效益，如果HCC风险≥0.43％，则占主导地位（ICER <0），这表明IT治疗策略所产生的成本低于信息技术战略。 IT治疗策略的成本效益方面最具影响力的参数是与HCC风险（HBV DNA水平，血小板计数和年龄）和药物成本相关的参数。

结论：在IT阶段开始抗病毒治疗与将治疗推迟到CHB患者开始活动性肝炎阶段相比具有成本效益，特别是在增加HCC风险，降低药物成本和考虑生产力损失的情况下。

关键词：抗病毒治疗；成本效益;乙肝

©作者（或其雇主）2020。不得商业重复使用。查看权限。由BMJ发布。