基于Markov模型对泛基因型直接抗病毒药物治疗慢性丙型肝炎的药物经济学评价
China Journal of Pharmaceutical Economics（2022）
Abstract
目的 评价已在中国上市的泛基因型直接抗病毒药物(DAAs)治疗方案与聚乙二醇干扰素(Peg-IFN)为基础的治疗方案用于慢性丙型肝炎(CHC)患者的经济性.方法 从中国医疗卫生体系视角出发,以中国初治CHC患者为目标人群,构建Markov模型.分别模拟非肝硬化和代偿性肝硬化CHC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-效用比(ICUR).采用敏感性分析验证结果的稳健性.结果 对于非肝硬化CHC患者,与传统的聚乙二醇干扰素联合利巴韦林(PR)方案比较,3种泛基因型DAAs方案均增加了QALYs而显著降低了终身医疗成本,均为绝对优势方案.对于代偿性肝硬化患者,索磷布韦/维帕他韦方案的QALYs最高而终身治疗成本最低,依然是绝对优势方案.格卡瑞韦/哌仑他韦和索磷布韦联合达拉他韦方案与传统PR方案比较,ICUR分别为3106.09元/QALY和80843.45元/QALY;前者小于本研究设定的意愿支付阈值70892元/QALY(2019年我国人均国内生产总值(GDP)),后者明显小于2019年国内人均GDP的3倍(212676元/QALY).因此与传统PR方案比较,格卡瑞韦/哌仑他韦和索磷布韦联合达拉他韦方案亦具有显著的药物经济学优势.敏感性分析结果验证了基础分析结果的稳健性.以最具经济学优势的索磷布韦/维帕他韦为对照方案,通过成本-效用分析和阈值分析,测算若格卡瑞韦/哌仑他韦和索磷布韦联合达拉他韦方案达到同等经济性,格卡瑞韦/哌仑他韦、索磷布韦和达拉他韦需分别降价80.5％、80.0％和82.3％.结论 对于非肝硬化和代偿性肝硬化CHC患者,所有泛基因型DAAs治疗方案均具有显著的药物经济学优势,其中索磷布韦/维帕他韦最具成本-效用优势.
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