Cost-effectiveness of 6 and 12 months of interferon-alpha therapy for chronic hepatitis C
Cost-effectiveness of 6 and 12 months of interferon-alpha therapy for chronic hepatitis C
复制标题
DOI：
10.7326/0003-4819-127-10-199711150-00002
复制
发表时间：
1997-11-15
影响因子：
39.2
通讯作者：
Gross, JB
中科院分区：
文献类型：
--
作者：
Kim, WR;Poterucha, JJ;Gross, JB
背景：干扰素-α 仅对少数慢性丙型肝炎患者有效，尽管长期治疗可能会提高缓解率。人们担心干扰素-α 治疗的费用可能不合理，因为反应率低且长期效益不确定。目的：比较慢性丙型肝炎接受干扰素-α 治疗 6 个月和 12 个月后的临床和经济结果。设计：描述慢性丙型肝炎自然进展的马尔可夫模型。在此模型的基础上，进行了一项模拟试验，比较了不治疗与标准剂量（300 万单位 3 次）干扰素 α 治疗 6 个月和 12 个月的情况。患者：四个特定年龄组（30、40、50 和 60 岁）患有慢性丙型肝炎。测量：肝病死亡人数、总费用和累积质量调整生命年 (QALY)。结果：干扰素 α 治疗 6 个月和 12 个月的增量成本为 1000 美元，增加了 0.25 QALY；增量成本为 1000 美元，增加了 0.37 QALY。分别为1900美元。因此，尽管 6 个月的干扰素-α 治疗效果不如 12 个月的治疗，但它更具成本效益（每增加 QALY 4000 美元，而每增加 QALY 5000 美元）。尽管如此，对于年龄小于 60 岁的患者，6 个月和 12 个月的治疗与其他既定的医疗干预措施（例如筛查乳房 X 光检查和降低胆固醇计划）相比，效果更好。影响干扰素-α治疗成本效益的重要变量包括干扰素-α的成本和疗效、失代偿性肝硬化的治疗成本以及慢性丙型肝炎患者的生活质量。结论：从成本效益的角度来看，慢性丙型肝炎患者接受干扰素-α治疗6或12个月可能是合理的。可能的例外是年龄超过60岁的患者。
Background: Interferon-alpha is effective in only a small number of patients with chronic hepatitis C, although prolonged treatment may increase the response rate. There is concern that the expense of interferon-alpha therapy may not be justified by the low response rates and uncertain long-term benefit.Objective: To compare clinical and economic outcomes after 6 months and 12 months of interferon-alpha therapy for chronic hepatitis C.Design: A Markov model depicting the natural progression of chronic hepatitis C. On the basis of this model, a simulated trial compared no therapy with 6 and 12 months of interferon-alpha therapy at standard doses (3 million U three times weekly).Patients: Four age-specific cohorts (30, 40, 50, and 60 years of age) with chronic hepatitis C.Measurements: Number of deaths from liver disease, total costs, and cumulative quality-adjusted life-years (QALYs).Results: Six and 12 months of interferon-alpha treatment gained 0.25 QALYs at an incremental cost of $1000 and 0.37 QALYs at an incremental cost of $1900, respectively. Thus, although 6 months of interferon-alpha therapy was less efficacious than 12 months of therapy, it was more cost-effective ($4000 per QALY gained compared with $5000 per QALY gained). Nonetheless, in patients younger than 60 years of age, both 6 and 12 months of therapy compared favorably with other established medical interventions, such as screening mammography and cholesterol reduction programs. Important variables affecting the cost-effectiveness of interferon-alpha treatment included the cost and efficacy of interferon-alpha, the cost of treatment for decompensated cirrhosis, and quality of life in patients with chronic hepatitis C.Conclusion: From the standpoint of cost-effectiveness, interferon-alpha therapy for 6 or 12 months may be justified in patients with chronic hepatitis C. The possible exception is patients older than 60 years of age.