4种抗病毒方案治疗乙型肝炎后肝硬化失代偿期的成本-效果分析

Cost-effectiveness Analysis of 4 Pharmacotherapeutic Schemes for Decompensated Hepatic Cirrhosis Secondary to Chronic Hepatitis B

目的:观察4种抗病毒方案治疗乙型肝炎后肝硬化失代偿期的成本-效果。方法:259例乙型肝炎肝硬化失代偿期患者按用药分组,分别给予拉米夫定、阿德福韦酯、拉米夫定+阿德福韦酯、恩替卡韦口服,疗程为48周,观察4组疗效并进行成本-效果分析。结果:拉米夫定组、阿德福韦酯组、拉米夫定+阿德福韦酯组、恩替卡韦组的成本分别为4972.8、2889.6、7862.4、13104.0元;HBV DNA转阴率分别为85.9%、88.3%、95.7%、95.5%;YMDD不变异率分别为90.6%、96.7%、100%、100%;HBV DNA转阴率成本-效果比分别为5789.1、3272.5、8215.7、13721.5;YMDD不变异率成本-效果比分别为5488.7、2988.2、7862.4、13104.0;在阿德福韦酯组的基础上,拉米夫定组、拉米夫定+阿德福韦酯组、恩替卡韦组HBV DNA转阴率增加单位效果所需成本分别为-86800.0、67200.0、141866.7,YMDD不变异率增加单位效果所需成本分别-34150.8、150690.9、309527.3。结论:拉米夫定+阿德福韦酯组方案为治疗乙型肝炎后肝硬化失代偿期最合理方案。

OBJECTIVE： To evaluate the cost-effectiveness of 4 therapeutic schemes in treatment of decompensated hepatic cir- rhosis secondary to chronic hepatitis B. METHODS： 259 patients with decompensated hepatic cirrhosis secondary to chronic hepati- tis B were randomly assigned into lamivudine group, adefovir dipivoxil group, lamivudine＋adefovir dipivoxil group, entecavir group. Treatment course lasted for 48 weeks. Therapeutic efficacies of 4 groups were observed and cost-effectiveness of treatments were analyzed. RESULTS： The cost of lamivudine group, adefovir dipivoxil group, lamivudine＋adefovir dipivoxil group, entecavir group was 4 972.8 yuan, 2 889.6 yuan, 7 862.4 yuan and 13 104.0 yuan respectively. Negative conversion rate of HBV DNA was 85.9%, 88.3%, 95.7% and 95.5% respectively. Non-variation incidence of YMDD was 90.6%, 96.7%, 100% and 100% respective- ly. Cost-effectiveness ratio of negative conversion rate of HBV DNA was 5 789.1, 3 272.5, 8 215.7 and 13 721.5 respectively. Cost-ef- fectiveness ratio of non-variation incidence of YMDD was 5 488.7, 2 988.2, 7 862.4 and 13 104.0 respectively. Based on adefovir dip- ivoxil group, the cost for increasing unit effect of negative conversion rate ofHBV DNA was --86 800.0, 67 200.0, 141 866.7 respec- tively in lamivudine group, lamivudine＋adefovir dipivoxil group, entecavir group, respectively; the cost for increasing unit effect of non-variation incidence of YMDD was --34 150.8, 150 690.9 and 309 527.3 respectively. CONCLUSION： Adefovir dipivoxil com- bined with lamivudine is the optimal scheme in the treatment of decompensated hepatic cirrhosis secondarv to chronic hepatitis B.