替诺福韦对乙型肝炎母婴阻断的成本-效果分析

Cost-effectiveness analysis of tenofovir in blocking mother-to-child transmission of hepatitis B

目的评价国产与进口替诺福韦对乙型肝炎(hepatitis B vireus,HBV)母婴阻断的成本-效果。方法筛选于南京市第二医院妇产科治疗且分娩的高载HBV妊娠患者,回顾性分析国产与进口替诺福韦在HBV母婴阻断中的临床疗效,采用成本-效果分析方法计算增量成本效果比,进行敏感性分析。结果符合入组标准的患者共计179例,国产组131例,进口组48例。国产组与进口组患者HBV DNA转阴率分别为45.04%和52.08%,HBV母婴阻断有效率分别为98.47%和100.00%,差异均无统计学意义(P>0.05)。国产组与进口组治疗总成本分别为(20313.73±11467.36)元和(20906.19±6211.43)元,差异无统计学意义(P>0.05);药品费用分别为(47.53±8.07)元和(1118.62±200.89)元,国产组显著低于进口组(P<0.05)。国产组对比进口组的增量成本效果比为700.05,小于意愿支付阈值;敏感性分析与原分析结果一致。结论国产与进口替诺福韦在进行HBV母婴阻断时的阻断有效率相当,而国产替诺福韦更具药物经济学优势,临床上建议根据患者实际需求合理选择药物。

Objective To evaluate the cost-effectiveness of domestic and imported tenofovir in blocking mother-to-child transmission of hepatitis B virus(HBV).Methods Pregnant patients with high HBV load who were treated and delivered at the Department of Obstetrics and Gynecology in the Second Hospital of Nanjing were enrolled in this study.A retrospective analysis was conducted to analyze clinical efficacy of domestic and imported tenofovir for mother-to-child transmission of HBV.The incremental cost-effectiveness ratio and sensitivity analysis was performed based on cost-effectiveness analysis.Results A total of 179 patients met the inclusion criteria,including 131 patients in the domestic group and 48 patients in the imported group.The positive-to-negative conversion rates of HBV DNA were 45.04%and 52.08%in the domestic group and the imported group respectively,while the rates of blocking mother-to-child transmission of HBV were 98.47%and 100.00%respectively,exhibiting no statistical significance(P>0.05).The total treatment costs of the domestic and imported groups were(20313.73±11467.36)yuan and(20906.19±6211.43)yuan,respectively,which did not demonstrate statistical significance(P>0.05),either.The drug expense of domestic group was observed to be significantly lower compared with its counterpart[(47.53±8.07)yuan vs.(1118.62±200.89)yuan,P<0.05].The incremental cost-effectiveness ratio of the domestic group and the imported group was 700.05,which was lower than the willing payment threshold of our country.This result was validated by sensitivity analysis.Conclusion The efficacy of domestic tenofovir is consistent with its imported counterpart on blocking mother-to-child transmission of hepatitis B,while the former has more pharmacoeconomic advantages.Consequently,it is recommended to select drugs rationally according to the practical requirements of patients in clinical practice.