A Cost-Effectiveness Analysis of Glecaprevir/Pibrentasvir Versus Existing Direct-Acting Antivirals to Treat Chronic Hepatitis C in Japan
A Cost-Effectiveness Analysis of Glecaprevir/Pibrentasvir Versus Existing Direct-Acting Antivirals to Treat Chronic Hepatitis C in Japan
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DOI：
10.1007/s12325-019-01166-3
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发表时间：
2019-12-05
影响因子：
3.8
通讯作者：
Kumada, Hiromitsu
中科院分区：
文献类型：
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作者：
Kawaguchi, Isao;Chayama, Kazuaki;Kumada, Hiromitsu
介绍本研究的目的是评价在日本治疗慢性丙型肝炎病毒（HCV）感染的格列卡普韦/pibentasvir与其他直接作用抗病毒药物（DAA）的成本效益。方法我们开发了一个健康状态转换模型来捕捉HCV的自然史。从日本公共医疗保健支付者的角度对DAA进行了成本效益分析，其寿命范围超过年度周期。治疗属性、基线人口统计学、转移概率、健康状态效用和成本数据均从出版物中提取。成本及结果按每年2%贴现。在基础病例中，我们关注基因型1（GT 1）未治疗的无肝硬化患者。情景分析检查了GT 1 -3中的泛基因型治疗（即，组合）、未接受过治疗的患者和接受过治疗的患者。DAA的组合成本效益是通过计算由治疗史、肝硬化状态和基因型定义的患者段的加权平均值得出的。结果基础病例结果表明，格列卡普韦/匹布他韦占主导地位（即，与所有其他DAA相比，产生更高的质量调整寿命年[QHMS]和更低的寿命成本）。预测的肝细胞癌终生风险分别为：格列卡普韦/pibentasvir和sofosbuvir/ledipasvir为3.66%，elbasvir/grazoprevir为4.99%，daclatasvir/asunaprevir/beclabuvir为5.27%。在情景分析中，基于索非布韦（SOF）的产品组合（即GT 1 -2中的索非布韦/ledipasvir和GT 3中的索非布韦+利巴韦林）中，格列匹韦/匹布他韦（GLE/PIB）产品组合占主导地位。基础病例概率敏感性分析（PSA）显示，对于支付意愿/QALY范围为160万至2000万日元（JPY）的模拟，93.4%的模拟中，格列卡普韦/匹布他韦具有成本效益。组合方案的PSA表明，在支付意愿/QALY达到520万日元之前，GLE/PIB组合在100%的模拟中具有成本效益;在支付意愿/QALY为2000万日元时，这一比例下降到69.4%。在确定性敏感性分析中，结果也是稳健的。结论在GT 1初治的非胰腺炎患者中，与其他DAA相比，GLE/PIB是一种具有成本效益的策略。当使用泛基因型框架时，GLE/PIB组合占主导地位的基于S 0 F的组合。
Introduction The objective of the study was to evaluate the cost-effectiveness of glecaprevir/pibrentasvir versus other direct-acting antivirals (DAAs) for treating chronic hepatitis C virus (HCV) infections in Japan. Methods We developed a health state transition model to capture the natural history of HCV. A cost-effectiveness analysis of DAAs from the perspective of a public healthcare payer in Japan with a lifetime horizon over annual cycles was performed. Treatment attributes, baseline demographics, transition probabilities, health-state utilities, and costs data were extracted from publications. Costs and outcomes were discounted at 2% per annum. In the base case we focused on genotype 1 (GT1) treatment-naive patients without cirrhosis. The scenario analysis examined a pan-genotype treatment in GT1-3 (i.e., portfolio), treatment-naive, and treatment-experienced patients. The portfolio cost-effectiveness of DAAs was derived by calculating a weighted average of patient segments defined by treatment history, cirrhosis status, and genotype. Results The base case results indicated that glecaprevir/pibrentasvir was dominant (i.e., generating higher quality-adjusted life years [QALYs] and lower lifetime costs) compared to all other DAAs. The predicted lifetime risk of hepatocellular carcinoma was 3.66% for glecaprevir/pibrentasvir and sofosbuvir/ledipasvir, 4.99% for elbasvir/grazoprevir, and 5.27% for daclatasvir/asunaprevir/beclabuvir. In scenario analysis the glecaprevir/pibrentasvir (GLE/PIB) portfolio dominated the sofosbuvir (SOF)-based portfolio (namely sofosbuvir/ledipasvir in GT1-2 and sofosbuvir + ribavirin in GT3). The base case probabilistic sensitivity analysis (PSA) showed that glecaprevir/pibrentasvir was cost-effective in 93.4% of the simulations for a willingness-to-pay/QALY range of Japanese yen (JPY) 1.6-20 million. The PSA for the portfolio scenario indicated that the GLE/PIB portfolio was cost-effective in 100% of simulations until the willingness-to-pay/QALY reached JPY 5.2 million; this proportion decreased to 69.4% at a willingness-to-pay/QALY of JPY 20 million. Results were also robust in deterministic sensitivity analyses. Conclusion In GT1 treatment-naive non-cirrhotic patients GLE/PIB was a cost-effective strategy compared to other DAAs. When a pan-genotypic framework was used, the GLE/PIB portfolio dominated the SOF-based portfolio.