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泛基因型直接抗病毒药物治疗慢性丙型肝炎的成本-效用分析
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篇名: 泛基因型直接抗病毒药物治疗慢性丙型肝炎的成本-效用分析
TITLE: Cost-utility Analysis of the Pan-genotypic Direct-acting Antivirals in the Treatment of Chronic Hepatitis C Infection
摘要: 目的:评价泛基因型直接抗病毒药物(DAAs)治疗慢性丙型肝炎患者的成本-效用,为相关医疗卫生决策提供药物经济学证据。方法:从全社会角度出发,以中国初治慢性丙型肝炎患者为目标人群,参考文献资料建立Markov模型,以索磷布韦维帕他韦为对照,分析格卡瑞韦派伦他韦、索磷布韦+可洛派韦治疗慢性丙型肝炎患者的质量调整生命年(QALYs)和增量成本-效用比(ICERs);采用敏感性分析验证结果的稳健性。结果:与索磷布韦维帕他韦相比,格卡瑞韦哌仑他韦增加了0.0021QALYs,成本增加25021元,ICERs为12129031元/QALY(意愿支付阈值为70892元/QALY),不具有成本-效用;当其单价下降至1679元时(降价64.65%)将具有成本-效用。索磷布韦+可洛派韦增加了0.0020QALYs,成本减少515元,是成本节约的绝对优势方案。敏感性分析显示,持续病毒学应答率和药品价格对结果的影响最大,索磷布韦+可洛派韦具有成本-效用的概率高于格卡瑞韦哌仑他韦。结论:格卡瑞韦哌仑他韦需大幅降低价格,才可达到更好的可负担性;索磷布韦+可洛派韦具有良好的经济性。
ABSTRACT: OBJECTIVE:To evaluate the cost-utility of the pan-genotypic direct-acting antivirals (DAAs)in the treatment of patients with chronic hepatitis C infection ,and to provide pharmacoeconomic evidence for relevant health care decisions. METHODS:A Markov model was established from a societal perspective with newly diagnosed chronic hepatitis C patients in China as the target population ,and analyzed quality-adjusted life years (QALYs)and incremental cost-utility ratios (ICERs)of patients with chronic hepatitis C with sofosbuvir/velpatasvir ,glecaprevir/pibrentasvir,sofosbuvir+coblopasvir. Sensitivity analysis was used to verity the robustness of the results. RESULTS :Glecaprevir/pibrentasvir increased QALYs by 0.002 1 and costs by 25 021 RMB,compared to sofosbuvir/velpatasvir ;its ICERs was 12 129 031 yuan/QALY(willingness to pay threshold was 70 892 yuan/QALY),which had no cost-utility ;glecaprevir/pibrentasvir need to cut down the price by 64.65% to have cost-utility. Sofosbuvir+coblopasvir increased QALYs by 0.002 0 and saved costs by 515 yuan,so it was the optimal regimen which was cost-saving. Sensitivity analysis showed that SVR rates and drug prices were the most influential factors. The probability of having cost-utility for sofosbuvir+coblopasvir was higher than glecaprevir/pibrentasvir. CONCLUSIONS :Glecaprevir/pibrentasvir need to reduce the price to achieve better affordability. Sofosbuvir+coblopasvir shows economical advantage.
期刊: 2021年第32卷第08期
编辑: 魏霞,杨莉
AUTHORS: WEI Xia ,YANG Li
关键字: 慢性丙型肝炎;直接抗病毒药物;成本-效用分析;Markov模型;泛基因型
KEYWORDS: Chronic hepatitis C virus infection ;Direct-acting antivirals ;Cost-utility analysis ;Markov model ;Pan-genotypic
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