丙型肝炎治疗药物经济学评价研究综述

Pharmacoeconomic evaluation on the treatment of chronic hepatitis C

丙型肝炎直接抗病毒药物(direct acting antivirals,DAAs)的出现极大地提高了丙肝的治疗效果,降低了丙肝长期并发症如肝硬化、肝癌、肝移植的发生率,显著提高了患者的生活质量;但DAAs药物也带来了更高的成本,潜在的治疗需求将成为极大的财政负担。因此,对DAAs药物进行经济学评价十分必要。通过系统评价了解国内外针对丙肝治疗药物的经济学评价研究现状,纳入34篇文献。目前的评价多采用模型法进行成本效用分析,以增量成本效果比(the incremental cost-effectiveness ratio,ICERs)为主要指标,绝大多数从付费方进行评价且只考虑了直接医疗成本,评价的结果因不同国家的不同患者而异,但大部分研究得出DAAs相比传统方案是具有成本效果的。未来丙肝治疗药物的经济学评价应从更全面的社会角度出发,并可探索通过多准则决策分析(multi-criteria decision analysis,MCDA)纳入包括患者在内的多方参与,以全面而准确地评价相应药物的成本和收益。

The emergence of direct acting antivirals(DAAs)has greatly improved the treatment for hepatitis C,reduced the incidence of long-term complications such as liver cirrhosis,liver cancer and liver transplantation,and improved the quality of life for patients.However,DAAs brought a higher cost at the same time and the potential demand of treatment would become a great financial burden for government.Therefore,it is necessary to evaluate the cost effectiveness of DAAs.To understand the current situation of economic evaluation researches on hepatitis C drugs at home and abroad through systematic review,34 literatures were included.At present,the model method was usually applied for cost-utility analysis and the incremental cost-effectiveness ratios(ICERs)were the most commonly used.The majority of evaluations were from the payer perspective and direct medical costs were considered only.The results of the evaluation varied from patients to patients in different countries,but most studies have concluded that DAAs were cost-effective compared to traditional regimens.In the future,the economic evaluation of hepatitis C treatment should be studied from a more comprehensive social perspective,and multi-criteria decision analysis(MCDA)can be explored to include the participation of multiple parties including patients,so as to comprehensively and accurately evaluate the cost and effectiveness of the drugs.