Prolonged treatment with interferon in patients with histologically mild chronic hepatitis C: a decision analysis
Prolonged treatment with interferon in patients with histologically mild chronic hepatitis C: a decision analysis
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DOI：
10.1046/j.1365-2893.1998.00119.x
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发表时间：
1998-09-01
影响因子：
2.5
通讯作者：
Poynard, T
中科院分区：
文献类型：
--
作者：
Davis, GL;Beck, JR;Poynard, T
短期（6个月）干扰素（IFN）治疗组织学轻度慢性丙型肝炎患者成本效益高。然而，持续12-24个月的IFN治疗现在是护理标准，我们利用了先前发表和验证的慢性丙型肝炎自然史模型和来自IFN γ-α 2b的两个大型多中心治疗试验的治疗结果，给予6个月或18-24个月，评估组织学轻度慢性丙型肝炎患者延长IFN治疗的增量成本效果（以前是慢性持续性或轻度慢性活动性肝炎），在两项治疗试验中，合并分析轻度肝炎患者显示，36.4%的患者血清丙氨酸氨基转移酶恢复正常，病毒阴性在完成18-24个月的IFN疗程后，持续应答率为15.3%，而在6个月的疗程中没有应答率为15.3%。然后，该模型估计，对于年龄为20-50岁的患者，长期IFN治疗获得的贴现后的每年生命边际成本范围为735美元至8856美元，预期寿命的增加范围为4.35年至0.75年，与未经治疗的年龄匹配队列相比。与治疗仅6个月相比。在20-50岁年龄段，延长治疗时间所获得的每生命年增量边际成本为938 - 9957美元。在敏感性分析中，治疗和保健成本、持续应答率和早期疾病进展率被确定为重要变量。然而，较长的治疗总是显示出生存的好处相比，6个月的干扰素或没有治疗，较长的治疗费用是合理的相比，为6个月的课程。
Short courses(6 months) of interferon (IFN) are highly cost-effective in patients with histologically mild chronic hepatitis C. However IFN treatment lasting 12-24 months is now the standard of care, We utilized a previously published and validated model of the natural history of chronic hepatitis C and the treatment outcomes from two large multicentre treatment trials of IFNY-alpha 2b, given for 6 months or 18-24 months, to estimate the incremental cost-effectiveness of prolonged IFN treatment in patients with histologically mild chronic hepatitis C (formerly chronic persistent or mild chronic active hepatitis), in the two treatment trials, pooled analysis of the patients with mild hepatitis showed that 36.4% of them normalized serum alanine aminotransferase and remained virus negative (sustained response) after completing an 18-24 month course of IFN vs 15.3% for a 6-month course and no response in the absence of treatment, The model then estimated that for patients aged 20-50 years, the discounted marginal cost per year of life gained by long-term IFN treatment ranged from US $735 to US $8856, and the gain in life expectancy ranged from 4.35 years to 0.75 years, respectively, compared with an untreated age-matched cohort. Compared with treatment for only 6 months. the incremental marginal cost per life year gained by longer treatment at age 20-50 years ranged from $938 to $9957, The treatment and healthcare costs, sustained response rates and the rate of progression during early disease were identified as significant variables in sensitivity analyses. However, longer treatment always showed a survival benefit compared with 6 months of IFN or no treatment, and the cost of longer treatment is reasonable compared with that for a 6-month course.