Cost-effectiveness of managing HBV reactivation in patients with resolved HBV infection treated with anti-CD20 antibody for B-cell non-Hodgkin lymphoma.
Cost-effectiveness of managing HBV reactivation in patients with resolved HBV infection treated with anti-CD20 antibody for B-cell non-Hodgkin lymphoma.
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DOI：
10.1038/s41598-022-10665-3
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发表时间：
2022-05-05
影响因子：
4.6
通讯作者：
Mizokami, Masashi
中科院分区：
文献类型：
--
作者：
Fujita, Misuzu;Kusumoto, Shigeru;Ishii, Itsuko;Iwata, Tadashi;Fujisawa, Takehiko;Sugiyama, Masaya;Hata, Akira;Mizokami, Masashi
对于经抗CD 20单克隆抗体治疗B细胞非霍奇金淋巴瘤的HBV感染消退患者，尚无管理HBV再激活的普遍建议。本研究比较了两种常用策略的成本-效果：预防性抗HBV核苷（酸）类似物治疗（Pro NAT）和HBV DNA监测后按需抗病毒治疗（HBV DNA监测）。使用决策树模型，增量成本效果比（ICER）表示为每质量调整生命年（QALY）获得的成本。成本效益的门槛定为5，000，000日元，相当于45，662美元。在基础病例分析中，根据ICER的计算，HBV DNA监测更具成本效益，每个QALY为132，048美元，远远超过45，662美元。即使在预定范围内改变每个参数值后，通过单向确定性灵敏度分析也始终获得相同的结果。10，000次模拟的概率敏感性分析也显示，在96.8%的病例中，HBV DNA监测比Pro NAT更具成本效益。因此，这项研究表明，HBV DNA监测是一个适当的管理措施，在日本从成本效益的角度来看。
There is no universal recommendation for managing the reactivation of HBV in patients with resolved HBV infection treated with anti-CD20 monoclonal antibodies for B-cell non-Hodgkin lymphoma. This study compared the cost-effectiveness of two commonly used strategies: prophylactic anti-HBV nucleos(t)ide analog therapy (Pro NAT), and HBV DNA monitoring followed by on-demand antiviral therapy (HBV DNA monitoring). Using a decision tree model, the incremental cost-effectiveness ratio (ICER) expressed as cost per quality-adjusted life-year (QALY) gained was calculated. The threshold for cost-effectiveness was set at 5,000,000 JPY, equivalent to 45,662 USD. In a base–case analysis, HBV DNA monitoring was found to be more cost-effective based on the calculation of ICER as 132,048 USD per QALY, a value that far exceeds 45,662 USD. The same results were consistently obtained by a one-way deterministic sensitivity analysis, even after changing each parameter value within the predetermined range. A probabilistic sensitivity analysis with 10,000 simulations also revealed that HBV DNA monitoring is more cost-effective than Pro NAT in 96.8% of cases. Therefore, this study suggests that HBV DNA monitoring is an appropriate managing measure in Japan from a cost-effectiveness perspective.
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