直接抗病毒药物治疗慢性丙型肝炎的成本效用分析

Cost utility analysis of direct-acting antiviral agents for chronic hepatitis C

目的评价已在中国上市的口服直接抗病毒药物(direct-acting antiviral agents,DAAs)治疗方案与长效干扰素(peginterferon,Peg-IFN)为基础的治疗方案用于慢性丙型肝炎(chronic hepatitis C,CHC)患者的经济性。方法基于基本医疗保险支付方角度,构建Markov模型。基于文献发表的真实世界临床疗效进行meta分析,对已在中国上市的口服DAAs治疗方案与Peg-IFN为基础的治疗方案治疗CHC进行成本效用分析。结果对基因1b型,艾尔巴韦(elbasvir,EBR)/格拉瑞韦(grazoprevir,GZR)人均获得14.9394质量调整生命年(quality-adjusted life years,QALYs),人均总医疗费用为27970元,相对于其他DAAs方案最具成本效果;对基因2型,索磷布韦(sofosbuvir,SOF)/维帕他韦(velpatasvir,Vel)人均获得15.0148 QALYs,人均总医疗费用是33941元,相对于其他DAAs方案最具有成本效果;对基因3型,SOF/Vel人均获得14.9403 QALYs,人均总医疗费用是34514元,相对于其他DAAs方案最具有成本效果;对基因6型,SOF/来迪派韦(ledipasvir,LDV)人均获得14.9407 QALYs,人均总医疗费用27929元,相对于其他DAAs方案最具有成本效果。结论针对不同基因型,DAAs治疗CHC最具有成本效果的方案分别为ERB/GZR(基因1b型)、SOF/Vel(基因2、3型)和SOF/LDV(基因6型)。

Objectives To conduct economic evaluation of all oral direct-acting antiviral agents(DAAs)which have been approved and launched in China versus peginterferon(Peg-IFN)-based regimen(PR)for chronic hepatitis C(CHC).Methods A markov model was developed from basic health insurance payer perspective.The meta analysis was carried out to obtain the effectiveness of DAAs from the published real world data.Cost utility analysis was conducted for all oral DAAs regimens and PR-based regimens.Results Elbasvir(EBR)/grazoprevir(GZR)was the most cost-effective regimen for genotype(GT)1b CHC patients compared with others,which achieved 14.9394 quality-adjusted life years(QALYs)per patient with total medical expenses per patient of 27970 yuan.Sofosbuvir(SOF)/velpatasvir(Vel)was the most cost-effective regimen for GT2 CHC patients and obtained 15.0148 QALYs per patient with total cost per patient of 33941 yuan.SOF/Vel was also most cost-effective for GT3 CHC patients and had 14.9403 QALYs per patient with total cost per patient of 34514 yuan.SOF/ledipasvir(LDV)was the most cost-effective for GT6 CHC,with 14.9407 QALYs obtained and 27929 yuan of total cost per patient.Conclusion For different genotypes,the most cost effective DAAs regimens for CHC were ERB/GZR(GT1b),SOF/Vel(GT2/3)and SOF/LDV(GT6).