Cost‐effectiveness of ursodeoxycholic acid therapy in primary biliary cirrhosis
Cost‐effectiveness of ursodeoxycholic acid therapy in primary biliary cirrhosis
复制标题
熊去氧胆酸治疗原发性胆汁性肝硬化的成本-效果
作者：
T. Pasha;J. Heathcote;S. Gabriel;K. Cauch‐Dudek;R. Jorgensen;T. Therneau;E. Dickson;K. Lindor
熊去氧胆酸（UDCA）是一种安全有效的治疗原发性胆汁性肝硬化（PBC）的药物，但该药物的成本引起了对成本-效果的担忧。我们研究的目的是确定UDCA在PBC中的成本效益。我们比较了治疗伴有和不伴有UDCA的PBC患者的成本和结果。根据先前发表的两项试验，UDCA的有效性是通过比较治疗组之间每年发生腹水、静脉曲张、静脉曲张出血、脑病、肝移植和死亡的减少来确定的。这些活动的平均年费用是根据文献和机构数据估计的。与UDCA组相比，安慰剂组发生的重大事件大约是UDCA组的两倍。与UDCA组相比，安慰剂组肝移植的相对风险（RR） （1.95; 95% CI: 1.14‐3.68）和食管静脉曲张的发生（3.11;95% CI: 1.57‐10.65）显著高于UDCA组。两组患者腹水、静脉曲张出血、脑病或死亡的RR均无显著升高。根据管理这些事件的估计年度成本和UDCA的年度成本（2,500美元），每位患者每年节省的成本为1,372美元。与安慰剂组相比，接受UDCA治疗的患者主要并发症发生率较低，医疗费用也较低。
Ursodeoxycholic acid (UDCA) is a safe and effective treatment for patients with primary biliary cirrhosis (PBC), but the cost of this drug has raised concerns regarding cost‐effectiveness. The aim of our study was to determine the cost‐effectiveness of UDCA in PBC. We compared the costs and outcomes of managing PBC patients with and without UDCA. From two previously published trials, the effectiveness of UDCA was determined by comparing the annual reduction in the development of ascites, varices, variceal bleeding, encephalopathy, liver transplantation, and death between the treatment groups. Average annual costs for each of these events were estimated based on literature and institutional data. Approximately twice as many major events occurred in the placebo group compared with the UDCA group. The relative risk (RR) of liver transplantation (1.95; 95% CI: 1.14‐3.68) and development of esophageal varices (3.11; 95% CI: 1.57‐10.65) were significantly higher in the placebo group compared with the UDCA group. There were no significant increases in the RR of ascites, variceal bleeding, encephalopathy, or death between the two groups. Based on the estimated annual cost of managing these events and the annual costs of UDCA ($2,500), there was an annual cost savings per patient of $1,372. Compared with the placebo group, patients receiving UDCA had a lower incidence of major complications and lower medical care costs.