基于Markov模型对新型抗病毒药物治疗基因1b型慢性丙型肝炎的药物经济学评价

杨馥宁, 贺小宁, 吴晶

中国药学杂志 ›› 2019, Vol. 54 ›› Issue (15) : 1276-1284.

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中国药学杂志
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中国药学杂志 ›› 2019, Vol. 54 ›› Issue (15) : 1276-1284. DOI: 10.11669/cpj.2019.15.016
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基于Markov模型对新型抗病毒药物治疗基因1b型慢性丙型肝炎的药物经济学评价

  • 杨馥宁, 贺小宁, 吴晶*
作者信息 +

Economic Evaluation of Novel Direct-Acting Antivirals in the Treatment of Chronic Hepatitis C Virus Genotype 1b in China Based on Markov Model

  • YANG Fu-ning, HE Xiao-ning, WU Jing*
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文章历史 +

摘要

目的 对中国初治的基因1b型慢性丙型肝炎患者的新型抗病毒药物(DAAs)方案进行成本-效果分析,为相关医疗卫生决策提供药物经济学证据。方法 根据慢性丙型肝炎疾病自然史构建Markov模型,从中国医疗卫生体系角度出发,分别模拟非肝硬化和代偿性肝硬化丙肝患者在不同治疗方案下获得的质量调整生命年(QALYs)和所花费的直接医疗成本,并计算增量成本-效果比(ICER)。模型循环周期为1年,模拟时限设定为终身(100岁),健康产出和成本均按5%进行贴现。在此基础上进行单因素敏感性分析和概率敏感性分析。结果 在主分析中,对于所有初治的基因1b型慢性丙型肝炎患者而言,与不接受治疗方案和传统的聚乙二醇干扰素+利巴韦林(PR)方案相比较,6个DAAs方案均增加了QALYs而节省了成本,为绝对优势方案;在所有的DAAs方案中,奥比帕利+达塞布韦±利巴韦林方案最具成本-效果优势。敏感性分析结果验证了主分析结果的稳健性。结论 在所有治疗方案中,奥比帕利+达塞布韦±利巴韦林方案治疗中国初治的基因1b型慢性丙型肝炎患者最具成本-效果。

Abstract

OBJECTIVE To evaluate the cost-effectiveness of combinations of different direct-acting antivirals(DAAs) for treatment-naive patients infected with chronic hepatitis C virus genotype 1b in China, which would provide pharmacoeconomic evidence for relevant health care decisions. METHODS A Markov model was constructed based on the natural history of chronic hepatitis C to evaluate the quality-adjusted life years (QALYs) and direct medical costs for noncirrhotic patients and compensated cirrhotic patients from the payer perspective, and to further calculate incremental cost-effectiveness ratio (ICER) of different regimens. Lifetime horizon(100 years of age) and one year cycle length were adopted. A 5% discount rate was applied to both QALYs and costs. One-way sensitivity analysis and probabilistic sensitivity analysis were performed. RESULTS Base-case analysis showed that six DAAs regimens not only gained QALYs but also reduced medical costs compared with no treatment and PR regimen. Among all the DAAs regimens, the combination of paritaprevir/ombitasvir/ritonavir+dasabuvir± ribavirin (POR+DAS±RBV) was the most cost-effective alternative for all the target population. The findings from the base-case analysis were confirmed by the sensitivity analyses. CONCLUSION Among all the regimens, the combination of POR+DAS±RBV is the economically dominant regimen in the treatment of treatment-naive patients infected with chronic hepatitis C virus genotype 1b in China.

关键词

慢性丙型肝炎 / 奥比帕利+达塞布韦±利巴韦林方案 / 成本-效果分析 / Markov模型

Key words

chronic hepatitis C / paritaprevir/ombitasvir/ritonavir+dasabuvir± / ribavirin / cost-effectiveness analysis / Markov model

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杨馥宁, 贺小宁, 吴晶. 基于Markov模型对新型抗病毒药物治疗基因1b型慢性丙型肝炎的药物经济学评价[J]. 中国药学杂志, 2019, 54(15): 1276-1284 https://doi.org/10.11669/cpj.2019.15.016
YANG Fu-ning, HE Xiao-ning, WU Jing. Economic Evaluation of Novel Direct-Acting Antivirals in the Treatment of Chronic Hepatitis C Virus Genotype 1b in China Based on Markov Model[J]. Chinese Pharmaceutical Journal, 2019, 54(15): 1276-1284 https://doi.org/10.11669/cpj.2019.15.016
中图分类号： R956   

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