Sofosbuvir-based treatment regimens for chronic, genotype 1 hepatitis C virus infection in U.S. incarcerated populations: a cost-effectiveness analysis.
Sofosbuvir-based treatment regimens for chronic, genotype 1 hepatitis C virus infection in U.S. incarcerated populations: a cost-effectiveness analysis.
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DOI：
10.7326/m14-0602
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发表时间：
2014-10-21
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;Watcha D;Holodniy M;Goldhaber-Fiebert JD
慢性丙型肝炎病毒（HCV）感染的患病率在美国的监禁人员中很高。新的、短期的、高效的疗法可能会扩大该人群的治疗资格。评估索非布韦用于监禁人群HCV治疗的成本效益。马尔可夫模型发表的文献和专家意见。未接受过治疗的慢性基因型1 HCV单一感染男性辈子社交无治疗、2种药物治疗（聚乙二醇干扰素和利巴韦林）或3种药物治疗（boceprevir或sofosbuvir）。对于剩余刑期较短（<1.5年）的囚犯，只有不治疗或索非布韦3种药物治疗是可行的;对于刑期较长（≥ 1.5年;平均10年）的囚犯，所有策略都被考虑在内。释放后，符合条件的人可以接受索非布韦3种药物治疗。贴现成本（以2013年美元计算）、贴现质量调整寿命年（QHRs）和增量成本效益比。这些策略分别为13.12、13.57、14.43和15.18个QURs。Sofosbuvir在失代偿性肝硬化（16%）和肝细胞癌（9%）中产生了最大的绝对减少，与不治疗相比，导致2.1个额外的Qdos，额外的成本超过54000美元。对于刑期较短的人，索非布韦每获得一个QALY的成本为25700美元，与没有治疗相比;对于刑期较长的人，索非布韦主要用于其他治疗，每获得一个QALY的成本为28800美元，与没有治疗相比。监狱中的高再感染率降低了长期服刑人员的成本效益。关于索非布韦长期有效性和价格的数据有限。该分析未考虑女性、西班牙裔人或合并感染HIV或B型肝炎病毒的患者。基于索非布韦的治疗对被监禁者具有成本效益，但负担能力是一个重要的考虑因素。国立卫生研究院。
Prevalence of chronic hepatitis C virus (HCV) infection is high among incarcerated persons in the United States. New, short-duration, high-efficacy therapies may expand treatment eligibility in this population. To assess the cost-effectiveness of sofosbuvir for HCV treatment in incarcerated populations. Markov model. Published literature and expert opinion. Treatment-naive men with chronic, genotype 1 HCV monoinfection. Lifetime. Societal. No treatment, 2-drug therapy (pegylated interferon and ribavirin), or 3-drug therapy with either boceprevir or sofosbuvir. For inmates with short remaining sentences (<1.5 years), only no treatment or sofosbuvir 3-drug therapy were feasible; for those with long sentences (≥1.5 years; mean, 10 years), all strategies were considered. After release, eligible persons could receive sofosbuvir 3-drug therapy. Discounted costs (in 2013 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios. The strategies yielded 13.12, 13.57, 14.43, and 15.18 QALYs, respectively, for persons with long sentences. Sofosbuvir produced the largest absolute reductions in decompensated cirrhosis (16%) and hepatocellular carcinoma (9%), resulting in 2.1 additional QALYs at an added cost exceeding $54 000 compared with no treatment. For persons with short sentences, sofosbuvir cost $25 700 per QALY gained compared with no treatment; for those with long sentences, it dominated other treatments, costing $28 800 per QALY gained compared with no treatment. High reinfection rates in prison attenuated cost-effectiveness for persons with long sentences. Data on sofosbuvir’s long-term effectiveness and price are limited. The analysis did not consider women, Hispanic persons, or patients co-infected with HIV or hepatitis B virus. Sofosbuvir-based treatment is cost-effective for incarcerated persons, but affordability is an important consideration. National Institutes of Health.