核苷（酸）类药物与聚乙二醇干扰素α-2a治疗HBeAg阴性慢性乙型肝炎的药物经济学评价

Pharmacoeconomic evaluation of treatments based on antiretrovirals for HBeAg-negative chronic hepatitis B

目的 对核苷（酸）类药物与聚乙二醇干扰素α-2a治疗HBeAg阴性慢性乙型肝炎进行药物经济学评价. 方法 根据慢性乙型肝炎进展的规律,构建含多个健康状态的Markov模型,使用模型估计不同方案治疗HBeAg阴性慢性乙型肝炎患者的长期效果和医疗费用,并进行增量分析.结果 与非抗病毒治疗相比,抗病毒治疗均能使患者生存年限延长,其中使用恩替卡韦（耐药后加阿德福韦酯）2年治疗效果最好,可以延长1.12个质量调整生命年;而使用拉米夫定2年（耐药后加阿德福韦酯）最具成本效果,可以延长0.95个质量调整生命年,增加的总医疗费用为15 459 元,每延长1个质量调整生命年多需的医疗费用为16 273元.结论 目前国内对HBeAg阴性慢性乙型肝炎的抗病毒治疗方案中,使用恩替卡韦（耐药后加用阿德福韦酯）可以达到最好的治疗效果,而使用拉米夫定（耐药后加阿德福韦酯）较之其他方案则更具有成本效果.

Objective To evaluate long-term cost-effectiveness of nucleoside analogues andpeg-interferon alfa-2a （peg-IFNα2a） for the treatment of chronic hepatitis B （CHB） in hepatitis B e antigen （HBeAg）-negative patients.Methods A multi-health slate Markov model was developed based on the disease progression pattern to estimate the long-term effect and medical expense of different treatments for HBeAg-negative CHB.Incremental cost-effectiveness analysis was then carried out.Results In comparison with no antiretroviral treatment,all of the antiretroviral treatments were capable of prolonging CHB patients＇ life years.In partcular,entecavir plus adefovir dipivoxil combination therapy showed the best 2 year survival,with expected life-years and quality-adjusted lifeyears （QALYs） being 19.59 years and 10.12 years,respectively,which were 1.46 years and 1.12 years better than with no antiretroviral treatment.The most cost-effective treatment for HBeAg-negative CHB was lamivudine plus adefovir dipivoxil rescue therapy,as it prolonged survival by 0.95 QALYs with an additional 15459 yuan; the incremental medical cost for gaining 1 QALY was 16273 yuan.Conclusion Among the antiretroviral medicines applied as therapy for HBeAg-negative CHB in China,the most effective treatment is entecavir plus adefovir dipivoxil rescue therapy and the most cost-effective treatment is lamivudine plus adefovir dipivoxil rescue therapy.