对慢性HBV感染者全部治疗策略的卫生经济学考量

Strategic considerations in health economics for the complete treatment of patients with chronic HBV infection

世界卫生组织于2016年发布《全球卫生部门战略》,明确提出在2030年实现降低90%的HBV新发感染率和降低65%的HBV相关死亡率。而目前全球的慢性HBV感染者仍有2.96亿,每年有近90万人死于HBV感染所致肝硬化及肝癌等。慢性HBV感染者抗病毒治疗可以有效抑制HBV复制,减轻肝脏炎症坏死、有效阻断和逆转肝纤维化甚至早期肝硬化,从而减少肝硬化相关并发症、降低肝癌和肝病相关死亡率。尽管国内外指南对于慢性乙型肝炎抗病毒治疗的适应证均已逐步放宽,但仍有相当数量的慢性乙型肝炎患者因不符合现有标准而未能接受抗病毒治疗,因而导致进展为更严重的疾病。通过对乙型肝炎流行病学、抗病毒药物治疗效果及国内外的指南治疗标准进行分析,判断指南中关键指标变化,综合考虑抗病毒治疗的覆盖率及治疗标准,探索提高覆盖率及治疗阈值降低后疾病负担变化和成本效果,以期尽早实现消除乙型肝炎作为公共卫生危害的全球战略目标。

The World Health Organization(WHO)released the Global Health Sector Strategy 2016,which explicitly proposes a 90%reduction in the new hepatitis B virus(HBV)infection rate and a 65%reduction in HBV-related mortality by 2030.However,at present,there are still 296 million chronic hepatitis B virus-infected patients worldwide,and nearly 900,000 patients die every year from cirrhosis and liver cancer caused by HBV infection.Antiviral treatment for chronic hepatitis B virus infection can effectively inhibit HBV replication,reduce liver inflammation and necrosis,effectively block and reverse liver fibrosis,and even early cirrhosis,thereby lowering cirrhosis-related complications,liver cancer,and liver disease-related mortality.Although the domestic and foreign guidelines have gradually eased antiviral treatment indications for chronic hepatitis B,there are still a considerable number of chronic hepatitis B patients with nonconformity who cannot receive antiviral treatment because they do not meet the existing standards,resulting in the progression of more severe diseases.This study analyzed the prevalence of hepatitis B,the therapeutic effect of antiviral drugs,domestic and international guideline treatment standards,the assessment of key indicators changes in the guidelines,comprehensively considered the coverage rate and treatment standards for antiviral treatment,and explored the changes in disease burden and cost-effectiveness following increasing the coverage rate and reducing treatment thresholds in order to achieve the global strategic goal of eliminating hepatitis B as soon as possible as a public health threat.