Cost-effectiveness of diagnostic and therapeutic interventions for chronic hepatitis C: a systematic review of model-based analyses.
Cost-effectiveness of diagnostic and therapeutic interventions for chronic hepatitis C: a systematic review of model-based analyses.
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DOI：
10.1186/s12874-018-0515-9
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发表时间：
2018-06-13
影响因子：
4
通讯作者：
Hyde C
中科院分区：
文献类型：
--
作者：
Castro R;Crathorne L;Perazzo H;Silva J;Cooper C;Varley-Campbell J;Marinho DS;Haasova M;Veloso VG;Anderson R;Hyde C
决定哪些慢性丙型肝炎（CHC）患者的亚组应该用直接作用的抗病毒药物（DAA）治疗具有经济重要性，因为药物价格高。尽管药物采购成本高，但CHC的所有DAA治疗策略已被接受。然而，也有成本与监测CHC，以确定一个亚组的患者有显着的损害。本系统评价的目的是描述所使用的建模方法，并总结CHC与DAA治疗和肝病监测的成本-效果分析（CEA）结果。检索了从开始到2015年5月的电子数据库，包括Embase和Medline。符合条件的研究包括预测CHC患者干预、监测或管理的成本和/或结果的模型。进行叙述性和定量综合。使用经验证的检查表进行质量评估。这项审查是根据NHS研究和传播中心公布的原则进行的。41个CEA符合审查的资格标准; 37个评估了干预措施，4个评估了针对那些可能获得最大益处的DAA治疗的监测策略。纳入的研究质量参差不齐，主要是由于报告遗漏。在37个评价性分析中，对8个能够进行比较分析的模型进行了充分评价和综合。这些模型在特定人群中的特定DAA比较中提供了非唯一的成本效益估计，该人群根据基因型、既往治疗状态和是否存在肝硬化定义。尽管进行了分层，但仍观察到成本-效果估计的显著异质性。大约一半的估计数表明，考虑到30，000美元的门槛，73%的估计数表明，考虑到50，000美元的门槛，DAA具有成本效益。两个评估监测策略的模型表明，无论肝病分期如何，治疗所有CHC患者都是具有成本效益的。CHC治疗的CEA需要更好地解释其估计值的可变性。这一分析表明，在某些情况下，DAA并不具有成本效益。监测代替治疗所有的战略可能仍然需要考虑作为一种选择部署DAA，特别是在采购成本是在一个给定的卫生系统的负担能力的极限。本文的在线版本（10.1186/s12874-018-0515-9）包含补充材料，可供授权用户使用。
Decisions about which subgroup of chronic hepatitis C (CHC) patients should be treated with direct acting anti-viral agents (DAAs) have economic importance due to high drug prices. Treat-all DAA strategies for CHC have gained acceptance despite high drug acquisition costs. However, there are also costs associated with the surveillance of CHC to determine a subgroup of patients with significant impairment. The aim of this systematic review was to describe the modelling methods used and summarise results in cost-effectiveness analyses (CEAs) of both CHC treatment with DAAs and surveillance of liver disease. Electronic databases including Embase and Medline were searched from inception to May 2015. Eligible studies included models predicting costs and/or outcomes for interventions, surveillance, or management of people with CHC. Narrative and quantitative synthesis were conducted. Quality appraisal was conducted using validated checklists. The review was conducted following principles published by NHS Centre for Research and Dissemination. Forty-one CEAs met the eligibility criteria for the review; 37 evaluated an intervention and four evaluated surveillance strategies for targeting DAA treatment to those likely to gain most benefit. Included studies were of variable quality mostly due to reporting omissions. Of the 37 CEAs, eight models that enabled comparative analysis were fully appraised and synthesized. These models provided non-unique cost-effectiveness estimates in a specific DAA comparison in a specific population defined in terms of genotype, prior treatment status, and presence or absence of cirrhosis. Marked heterogeneity in cost-effectiveness estimates was observed despite this stratification. Approximately half of the estimates suggested that DAAs were cost-effective considering a threshold of US$30,000 and 73% with threshold of US$50,000. Two models evaluating surveillance strategies suggested that treating all CHC patients regardless of the staging of liver disease could be cost-effective. CEAs of CHC treatments need to better account for variability in their estimates. This analysis suggested that there are still circumstances where DAAs are not cost-effective. Surveillance in place of a treat-all strategy may still need to be considered as an option for deploying DAAs, particularly where acquisition cost is at the limit of affordability for a given health system. The online version of this article (10.1186/s12874-018-0515-9) contains supplementary material, which is available to authorized users.
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影响因子：
4.4
作者：
Blazquez-Perez, Antonio;San Miguel, Ramon;Mar, Javier
通讯作者：
Mar, Javier
影响因子：
3.7
作者：
Brogan, Anita J.;Talbird, Sandra E.;Deniz, Baris
通讯作者：
Deniz, Baris
影响因子：
25.7
作者：
Camma, Calogero;Petta, Salvatore;Craxi, Antonio
通讯作者：
Craxi, Antonio
DOI：
10.1586/14737167.2015.1081061
发表时间：
2016-03-03
影响因子：
2.3
作者：
Gimeno-Ballester, Vicente;Mar, Javier;San Miguel, Ramon
通讯作者：
San Miguel, Ramon
影响因子：
13.5
作者：
HOUGHTON, M;WEINER, A;CHOO, QL
通讯作者：
CHOO, QL