重组α干扰素治疗慢性乙型肝炎和慢性丙型肝炎的经济学分析

Economic analysis of recombinant interferon alpha 2b in the treatment of chronic hepatitis B and chronic hepatitis C

目的 研究应用干扰素α２ｂ（ＩＦＮα２ｂ）治疗慢性乙型肝炎（ 慢乙肝） 和慢性丙型肝炎（ 慢丙肝）的长期经济学效果和效益。方法 根据全国１２ 个教学医院提供的６５００ 例慢乙肝资料，分成二个队列，其中２９５４ 例为ＩＦＮ 治疗组（乙型２１９８ 例，丙型７５６ 例）；３ ５４６ 例为非ＩＦＮ治疗组（乙型２ ６４２ 例，丙型９０４ 例） 。同时应用ＭＥＤＬＩＮＥ和中国生物医学光盘文献数据库（ＣＢＭＤ） 检索有关慢乙肝、慢丙肝自然病程、转归和ＩＦＮ 治疗效果的资料进行分析。所有数据应用决策分析软件，在微电脑上用Ｍａｒｋｏｖ 模型模拟分析。结果 慢乙肝和慢丙肝治疗后，３０ 年内发展为代偿性、非代偿性和原发性肝细胞癌的转化率显著降低（ Ｐ＜０ ．０５）。在３０ 年内，慢乙肝和慢丙肝分别多存活５．３２ 年和４．０６ 年，生命质量调整年增加５ ．４１ 年和４．２７ 年。为增加一个生命质量调整年贴现前分别节约５ １８０ 和９ ０６６ 元人民币，贴现后节约２ ５０９ 和３７２２ 元。３０ 年内应用ＩＦＮ 总的直接医疗费用节约，慢乙肝贴现前为４２ ８２０ 元，贴现后为２５０９７ 元；慢丙肝贴现前为６５４４０ 元，贴现后为３３ ３８２ 元。结论 对于有适应证的慢乙肝和慢?

Objective The aim of this study is to evaluate the long term economic impact and benefit of treatment of chronic hepatitis B and C with interferon α 2b. Methods Data of 6?500 patients with chronic hepatitis B and C from 12 teaching hospitals in different areas of China were collected and analyzed. Cohorts of these patients with either chronic hepatitis B (2?198 cases) or chronic hepatitis C (756 cases) treated with IFNα 2b were compared with a non IFN treated cohort (B 2?642 and C 904 cases). Data sources regarding natural history, progression, efficacy and costs of IFN therapy from MEDLINE and Chinese Bio Medical Database (CBMD) search were also included. Using a decision analysis software program, Markov computer simulation was performed to estimate the progression of disease and economic analysis. Results The 30 years disease progression to compensated and uncompensated cirrhosis, hepatocellular carcinoma both in chronic hepatitis B and C in IFN treated cohort were significantly decreased in comparison with non IFN treated cohort. The results suggested that IFN treatment could increase life expectancy by 5.32 years in chronic hepatitis B and 4.06 years in chronic hepatitis C, respectively. In IFN treated group, the quality adjusted life years would increase by 5.41 and 4.27 years. The cost to improve the quality adjusted life per year could save 5?180 Yuan RMB or 9 066 Yuan RMB in either chronic B or C patients treated with IFN α2b. Within a 30 years period, the total direct medical costs will be saved 42?820 Yuan RMB and 65 440 Yuan RMB in chronic hepatitis B and C patients treated with IFNα 2b. Conclusion IFNα 2b therapy can prolong the life expectancy, quality of life and lower the medical costs for patients with chronic hepatitis B and C.