New protease inhibitors for the treatment of chronic hepatitis C: a cost-effectiveness analysis.
New protease inhibitors for the treatment of chronic hepatitis C: a cost-effectiveness analysis.
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DOI：
10.7326/0003-4819-156-4-201202210-00005
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发表时间：
2012-02-21
影响因子：
39.2
通讯作者：
Goldhaber-Fiebert JD
中科院分区：
文献类型：
--
作者：
Liu S;Cipriano LE;Holodniy M;Owens DK;Goldhaber-Fiebert JD
慢性丙型肝炎(丙型肝炎)是一种难以治疗的疾病，影响着300多万美国人。蛋白水解酶抑制剂可以提高标准疗法的有效性，但价格昂贵。基因测试可能确定最有可能从这一治疗进展中受益的患者。用于治疗慢性丙型肝炎的新的蛋白酶抑制剂和白介素28B(IL-28B)基因分型试验的成本-效果评估--发表的文献和专家意见治疗决策分析马尔可夫模型-患有慢性、1型丙型肝炎单一感染的幼稚患者终生社会策略由IL-28B基因分型和治疗类型(标准治疗：聚乙二醇化干扰素与利巴韦林；三联疗法：标准治疗和一种蛋白酶抑制剂)定义。IL-28B引导的三联疗法将CC基因型患者分层到标准治疗，将非CC类型患者分层到三联治疗。折扣成本(2010美元)和质量调整寿命年(QALY)；对于轻度和晚期纤维化患者，普遍三联疗法与标准疗法相比，可将肝癌的寿命风险降低39%和29%，并将质量调整后的预期寿命提高3%和8%。从IL-28B引导的三联疗法中获得的收益较小。如果蛋白酶抑制剂每周花费1100美元，与IL-28B引导的三联疗法相比，通用三联疗法每QALY(轻度纤维化)的成本为102,600美元或每QALY(晚期纤维化)51,500美元，与标准疗法相比，每QALY和36,300美元的成本分别为70,100美元和36,300美元。结果对蛋白酶抑制剂的成本和治疗依从率很敏感。缺乏新的酶抑制剂的长期比较有效性数据，通用三联疗法和IL-28B引导的三联疗法对于晚期纤维化患者来说都是成本效益高、价格最低的酶抑制剂。斯坦福大学研究生奖学金
Chronic hepatitis C (HCV) is a difficult to treat disease affecting over 3 million Americans. Protease inhibitors increase the effectiveness of standard therapy but are costly. A genetic assay may identify patients most likely to benefit from this treatment advance. Cost-effectiveness assessment of new protease inhibitors and an Interleukin-28B (IL- 28B) genotyping assay for treating chronic HCV Decision-analytic Markov model Published literature and expert opinion Treatment-naïve patients with chronic, genotype 1 HCV mono-infection Lifetime Societal Strategies are defined by the use of IL-28B genotyping and type of treatment (standard therapy: pegylated interferon with ribavirin; triple therapy: standard therapy and a protease inhibitor). IL-28B guided triple therapy stratifies CC genotype patients to standard therapy and non-CC types to triple therapy. Discounted costs (2010 U.S. dollars) and quality-adjusted life years (QALYs); incremental cost effectiveness ratios For patients with mild and advanced fibrosis, universal triple therapy reduces life-time risk of hepatocellular-carcinoma by 39% and 29% and increases quality-adjusted life expectancy by 3% and 8% compared to standard therapy. Gains from IL- 28B guided triple therapy are smaller. If the protease inhibitor costs $1,100 per week, universal triple therapy costs $102,600 per QALY (mild fibrosis) or $51,500 per QALY (advanced fibrosis) compared to IL-28B guided triple therapy and $70,100 per QALY and $36,300 per QALY compared to standard therapy. Results are sensitive to the cost of protease inhibitors and treatment adherence rates. Lack of long-term comparative effectiveness data on the new protease inhibitors Both universal triple therapy and IL-28B guided triple therapy are cost-effective with the least expensive protease inhibitor for patients with advanced fibrosis. Stanford Graduate Fellowship
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影响因子：
13.5
作者：
Ghany, Marc G.;Nelson, David R.;Strader, Doris B.;Thomas, David L.;Seeff, Leonard B.
通讯作者：
Seeff, Leonard B.
影响因子：
24.5
作者：
Grieve, R.;Roberts, J.;Thomas, H.
通讯作者：
Thomas, H.
影响因子：
9.8
作者：
Chong, CAKY;Gulamhussein, A;Krahn, M
通讯作者：
Krahn, M
影响因子：
39.2
作者：
Jensen, Donald M.;Marcellin, Patrick;Tietz, Andreas
通讯作者：
Tietz, Andreas
影响因子：
4.5
作者：
Barton, Garry R.;Briggs, Andrew H.;Fenwick, Elisabeth A. L.
通讯作者：
Fenwick, Elisabeth A. L.