Cost effectiveness of interferon or peginterferon with ribavirin for histologically mild chronic hepatitis C
Cost effectiveness of interferon or peginterferon with ribavirin for histologically mild chronic hepatitis C
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DOI：
10.1136/gut.2005.064774
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发表时间：
2006-09-01
期刊：
影响因子：
24.5
通讯作者：
Thomas, H.
中科院分区：
文献类型：
--
作者：
Grieve, R.;Roberts, J.;Thomas, H.
背景：对于轻度慢性丙型肝炎患者，抗病毒治疗的成本效益尚不清楚。目标：为了评估是否抗病毒治疗（干扰素α或聚乙二醇干扰素α与利巴韦林结合）是成本效益在一个温和的阶段相比，等待和只治疗那些情况下谁进展到中度diseases.Patients：轻度慢性丙型肝炎的病例。方法：一个成本效益模型，估计长期的成本和结果为轻度慢性丙型肝炎患者。该模型使用的有效性和成本数据从英国轻度丙型肝炎随机对照试验，结合估计的疾病进展和成本从observational studies.Results：抗病毒治疗在轻度，而不是一个中等阶段改善的结果测量的质量调整生命年（QHMS）获得。与没有治疗相比，在轻度阶段，干扰素α-2b和利巴韦林抗病毒治疗获得的每个QALY的平均成本为4535磅（7108美元），对于基因型非1型患者为25磅188（39480美元）。在轻度而非中度阶段提供聚乙二醇干扰素-2b磅和利巴韦林也与QALY的增加有关;基因型非1和28磅的患者每增加一个QALY的成本分别为7821磅（12259美元）和409磅。基因1型患者的平均治疗费用为44528美元。对于慢性丙型肝炎患者，在轻度而不是中度疾病阶段提供抗病毒治疗通常更具成本效益。对于基因型1的老年患者（65岁或以上），在轻度阶段进行抗病毒治疗不具有成本效益。
Background: For patients with mild chronic hepatitis C the cost effectiveness of antiviral therapy is unknown. Aims: To assess whether antiviral therapy (either interferon alpha or peginterferon alpha combined with ribavirin) is cost effective at a mild stage compared with waiting and only treating those cases who progress to moderate disease.Patients: Cases with mild chronic hepatitis C.Methods: A cost effectiveness model which estimates long term costs and outcomes for patients with mild chronic hepatitis C. The model uses effectiveness and cost data from the UK mild hepatitis C randomised controlled trial, combined with estimates of disease progression and cost from observational studies.Results: Antiviral treatment at a mild rather than a moderate stage improved outcomes measured by quality adjusted life years (QALYS) gained. The mean cost per QALY gained from antiviral treatment with interferon alpha-2b and ribavirin, compared with no treatment at a mild stage, was 4535 pound ($7108) for patients with genotype non-1 and 25 pound 188 ($ 39 480) for patients with genotype 1. Providing peginterferon -2b pound and ribavirin at a mild rather than a moderate stage was also associated with a gain in QALYS; the costs per QALY gained were 7821 pound ($12 259) for patients with genotype non-1 and 28 pound 409 ($ 44 528) for patients with genotype 1.Conclusions: For patients with chronic hepatitis C, it is generally more cost effective to provide antiviral treatment at a mild rather than a moderate disease stage. For older patients (aged 65 years or over) with genotype 1, antiviral treatment at a mild stage is not cost effective.