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Cost-effectiveness of Screening of Hepatocellular Carcinoma under the Condition of Interferon Therapy for the Patients of Hepatitis C Virus Infection

丙型肝炎病毒感染患者干扰素治疗条件下肝癌筛查的成本效益

基本信息

批准号：
15390166
负责人：
INOUE Yuji
金额：
$ 4.61万
依托单位：
Yamaguchi University
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (B)
财政年份：
2003
资助国家：
日本
起止时间：
2003 至 2005
项目状态：
已结题

项目摘要

We could obtain the following results by this research grant.1.The effect of periodic screening test for hepatocellular carcinoma (HCC) : After conducting the retrospective survey of the regularity in pattern of outpatients visits for the HCC patients, the size of HCC detected in the patients with the regular office visit significantly smaller than those with irregular office visit. The results from the Cox-proportional hazard analysis showed the survival of the patients with tumor less than 20mm in diameter would be better significantly than those with tumor more than 20mm.2.Cost-effectiveness of periodic screening test for HCC in patients received interferon therapy : we made the Markov model combined the natural history of type C hepatitis and the effect of the periodic screening and interferon therapy. The result of model simulation for typical cohort with initially chronic hepatitis state revealed the marginal cost-effectiveness ratio of the periodic screening test versus non-scre … More ening would fall in the range of international consensus even the patients received the interferon therapy for chronic hepatitis if the periodic screening could detect the HCC less than 20mm in its diameter.3.The estimation of inpatient cost for HCC : The inpatients cost of patients hospitalized due to HCC was surveyed retrospectively and analyzed statistically. As a result of multivariate analysis, a model consisted of several variables of medical intervention ; resection, chemo-lipiodol therapy and parental anticancer agent injection, and complication ; ascites and edema, and variceal bleeding in addition to the period of hospitalization was obtained. It predicted inpatient cost with the high correlation coefficient for the validation dataset. This study suggested that the model consisted of several specific medical interventions corresponding to each complication or treatment could estimate the inpatients cost appropriately4.Evaluation of a cost-effectiveness model for the interventions to the different HCC stage : we created a state-transition Markov model which represented the principal health states of chronic hepatitis, cirrhosis, and decompensated cirrhosis with or without HCC. We assumed that the treatment choice corresponded to HCC state features such as maximal size, number and location, that treatment would start with resection or local ablation, including PEI and RFA, and that, as HCC progressed, local ablation plus transarterial chemoembolization (TACE), TACE, hepatic arterial infusion chemotherapy (HAIC) and conservative treatment would be applied. When it was applied for the evaluation of the cost-effectiveness of the treatments for solitary small HCC, the predicted survival rate was consistent with those of a sample population at our institution and of a nationwide survey of Japan. Less

通过本次研究经费，我们可以得到以下结果： 1.定期筛查肝细胞癌（HCC）的效果：对HCC患者门诊规律性进行回顾性调查后发现，定期就诊的患者检出的HCC大小明显小于不定期就诊的患者。 Cox比例风险分析结果显示，肿瘤直径小于20mm的患者的生存率明显优于肿瘤直径大于20mm的患者。2.接受干扰素治疗的患者定期筛查HCC的成本效果：结合丙型肝炎的自然病程以及定期筛查和干扰素治疗的效果，建立了马尔可夫模型。对初始慢性肝炎状态的典型队列的模型模拟结果显示，如果定期筛查能够检出直径小于20mm的HCC，则定期筛查与不筛查的边际成本效益比即使在慢性肝炎接受干扰素治疗的情况下也将落入国际共识范围。 3. HCC住院费用的估算：对因肝癌住院的患者的住院费用进行回顾性调查并进行统计分析。作为多变量分析的结果，模型由医疗干预的多个变量组成；切除、化疗碘油治疗和亲代抗癌剂注射以及并发症；除住院期间外，还获得了腹水和水肿以及静脉曲张出血情况。它通过验证数据集的高相关系数来预测住院费用。本研究表明，该模型由与每种并发症或治疗相对应的几种具体医疗干预措施组成，可以适当估计住院患者的费用。 4.针对不同 HCC 阶段的干预措施的成本效益模型评估：我们创建了一个状态转换马尔可夫模型，该模型代表慢性肝炎、肝硬化和伴或不伴 HCC 失代偿性肝硬化的主要健康状态。我们假设治疗选择与HCC状态特征相对应，例如最大大小、数量和位置，治疗将从切除或局部消融开始，包括PEI和RFA，并且随着HCC的进展，将应用局部消融加经动脉化疗栓塞（TACE）、TACE、肝动脉灌注化疗（HAIC）和保守治疗。当它被用于评估孤立性小肝癌治疗的成本效益时，预测的生存率与我们机构的样本人群和日本全国调查的结果一致。较少的