Cost-effectiveness analysis of simeprevir with daclatasvir for non-cirrhotic genotype-1b-naive patients plus chronic hepatitis C
Cost-effectiveness analysis of simeprevir with daclatasvir for non-cirrhotic genotype-1b-naive patients plus chronic hepatitis C
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DOI：
10.1586/14737167.2015.1081061
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发表时间：
2016-03-03
影响因子：
2.3
通讯作者：
San Miguel, Ramon
中科院分区：
文献类型：
--
作者：
Gimeno-Ballester, Vicente;Mar, Javier;San Miguel, Ramon
背景：无干扰素联合治疗的成本仍然很高，以提供广泛的治疗，无论纤维化阶段。目的：评估Simeprevir/daclatasvir（SMV/DCV）治疗初治慢性丙型肝炎基因型-1b伴中度肝纤维化患者的成本-效果。方法：建立马尔可夫模型，模拟慢性丙型肝炎进展的自然史。该模型从西班牙国家医疗保健系统的角度估计了一组患者的终身医疗保健成本和质量调整生命年（QALY）。所考虑的成本效益阈值为40 000欧元/质量调整生命年。分析的治疗策略为SMV/DCV、聚乙二醇干扰素/利巴韦林/特拉匹韦和聚乙二醇干扰素/利巴韦林/博赛匹韦。进行了敏感性分析。结果如下：对于中度纤维化的1b基因型患者，与特拉匹韦或博赛匹韦三联疗法相比，SMV/DCV策略的增量成本-效果比分别为23，774欧元/QALY和28，524欧元/QALY。结论：与第二代直接作用抗病毒药物到达之前的标准治疗相比，SMV/DCV组合低于普遍接受的支付意愿阈值。获得的结果应得到正在进行的临床试验的支持。
Background: The cost of interferon-free combination therapies remains high to provide widespread access to treatment, regardless of fibrosis stage. Aim: To estimate the cost-effectiveness of simeprevir/daclatasvir (SMV/DCV) therapy in treatment-naive chronic hepatitis C genotype-1b patients with moderate fibrosis. Methods: A Markov model was developed to simulate the natural history of chronic hepatitis C progression. The model estimated lifetime healthcare costs and quality-adjusted life-years (QALY) for a cohort of patients from the Spanish National Healthcare System perspective. The cost-effectiveness threshold considered was euro40,000/QALY. The treatment strategies analyzed were SMV/DCV, peginterferon/ribavirin/telaprevir, and peginterferon/ribavirin/boceprevir. A sensitivity analysis was carried out. Results: The incremental cost-effectiveness ratios of the SMV/DCV strategy were euro23,774/QALY and euro28,524/QALY compared with that of telaprevir or boceprevir triple therapy, respectively, for genotype-1b patients with moderate fibrosis. Conclusions: SMV/DCV combination compared with the standard of care previous to the arrival of second-generation direct-acting antivirals fell below generally accepted willingness-to-pay threshold. Results obtained should be supported by ongoing clinical trials.