Cost-effectiveness of IL28Β genotype-guided protease inhibitor triple therapy versus standard of care treatment in patients with hepatitis C genotypes 2 or 3 infection.
Cost-effectiveness of IL28Β genotype-guided protease inhibitor triple therapy versus standard of care treatment in patients with hepatitis C genotypes 2 or 3 infection.
复制标题
IL28α 基因型引导的蛋白酶抑制剂三联疗法与丙型肝炎基因型 2 或 3 感染患者标准护理治疗的成本效益。
DOI：
10.1159/000365939
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发表时间：
2014
影响因子：
1.7
通讯作者：
Williams,MarcS
中科院分区：
文献类型：
--
作者：
Bock,JonathanA;Fairley,KimberlyJ;Smith,RobertE;Maeng,DanielD;Pitcavage,JamesM;Inverso,NicholasA;Williams,MarcS
背景/目的：三联疗法[在标准护理(SOC)中加入蛋白酶抑制剂]显著提高了部分丙型肝炎病毒(丙型肝炎病毒)患者的治疗反应。白细胞介素28B(IL28Β)基因分型有助于预测这些患者的应答；然而，IL28Β基因分型在丙型肝炎病毒2型或3型感染患者中的经济意义尚不清楚。计算SOC治疗的短期和长期成本和结果，并用于确定丙型肝炎病毒2型或3型感染患者使用三联疗法的成本-效果阈值。方法：通过对决策树模拟SOC和三联疗法进行队列模拟来计算成本和结果。通过马尔可夫模型预测质量调整后的预期寿命和长期成本。结果：为了使三联疗法具有成本效益，丙型肝炎病毒2型和3型患者的持续病毒学应答率(SVR)必须分别提高7.91-11.11%和9.06-12.8%(取决于年龄)。当2IL28Β变种指导三联疗法时，从成本效果来看，需要将SVR提高2.63-3.72%，而当仅由一种变种指导时，需要提高1.4-8.91%。结论：马尔可夫模型显示，从长远来看，IL28Β指导的三联疗法的SVR率略有增加，可以导致更低的成本和更好的健康结果。
Background/Aims:Triple therapy [adding protease inhibitors to standard of care (SOC)] dramatically increases treatment response in selected patients with hepatitis C virus (HCV). Interleukin 28B(IL28Β)genotyping helps predict responsiveness in these patients; however, the economic implications ofIL28Βgenotyping in HCV genotype 2 or 3 infected patients are unknown. Short- and long-term costs and outcomes of SOC therapy were calculated and used to determine the cost-effectiveness thresholds for using triple therapy in HCV genotype 2 or 3 infected patients.Methods:Costs and outcomes were calculated by conducting cohort simulations on decision trees modeling SOC and triple therapy. Quality-adjusted life expectancies and long-term costs were predicted through Markov modeling.Results:For triple therapy to be cost-effective, sustained virologic response (SVR) rates must improve (depending on age) by 7.91-11.11 and 9.06-12.8% for HCV genotype 2 and 3 cohorts, respectively. When triple therapy is guided by 2IL28Βvariants, a 2.63-3.72% improvement in SVR is needed for cost-effectiveness, and when guided by only one variant, a 1.4-8.91% improvement is needed.Conclusions:Markov modeling revealed that modest increases in SVR rates fromIL28Β-guided triple therapy can lead to both lower costs and better health outcomes than SOC therapy in the long run.