3种方案治疗慢性乙型肝炎YMDD变异的成本-效果分析

目的:评价3种方案治疗慢性乙型肝炎YMDD变异患者的成本-效果。方法:将90例患者随机分为3组,A组采用阿德福韦酯与拉米夫定联合治疗12周后,单用阿德福韦酯治疗36周;B组采用阿德福韦酯与拉米夫定联合治疗48周;C组接受恩替卡韦治疗48周。运用药物经济学方法分析其成本-效果。结果:A、B、C组HBV DNA转阴率成本-效果比分别为12685.6、15481.3、31462.2;以A组为参照,B、C组增量成本-效果比为29501.5、106907.8。A、B、C组丙氨酸氨基转移酶复常率成本-效果比分别为12685.6、14284.9、31462.2;以A组为参照,B、C组增量成本-效果比为19618.5、106907.8。A、B、C组HBeAg/HBeAb转换率成本-效果比分别为76227.9、93120.3、209664.0;以A组为参照,B、C组增量成本-效果比为178350.0、1267621.4。A组治疗48周出现rtA181V和rtN236T变异各1例。结论:B组方案为治疗慢性乙型肝炎YMDD变异患者的较优选择。

Cost - Effectiveness Analysis of 3 Therapeutic Schemes for Chronic Hepatitis B with YMDD Mutation

OBJECTIVE： To evaluate the cost - effectiveness of 3 therapeutic schemes in the treatment of chronic Hepatitis B with YMDD mutation. METHODS： 90 patients were randomly assigned into three groups： the patients in Group A were assigned to receive Adefovir Dipivoxil in combination with Lamivudine for 12 weeks followed by administration of Adefovir alone for 36 weeks; Group B received Adefovir in combination with Lamivudine for 48 weeks, while Group C received Entecavir alone for 48 weeks. The cost - effectiveness of the 3 groups were analyzed. RESULTS： In the three groups （A, B, and C）, the cost - effectiveness ratios for HBV DNA negative - conversion ratewere 12 685.6, 15 481.3, and 31 462.2, respectively and the incremental cost effectiveness ratios of Group B and Group C were 29 501.5 and 106 907.8 respectively as against Group A. The cost- effectiveness ratios of the three Groups （A, B, and C） for serum alanine aminotransferase normalization rate were 12 685.6,14 284.9, 31 462.2 respectively, and the incremental cost effectiveness ratios of Group B and Group C were 19 618.5 and 106 907.8 respectively as against Group A. The cost- effectiveness ratios of the three Groups （A, B, and C） for HBeAg/ HBeAb seroconversion rate were 76 227.9, 93 120.3, and 209 664.0 respectively, and the incremental cost - effectiveness ratios of Group B and Group C were 178 350.0 and 1 267 621.4 respectively as against Group A. In Group A, 1 case showed rtA181V mutation and another one showed rtN236T mutation after 48 week treatment. CONCLUSION： Group B （ADV in combination with LAM） is more cost- effective in the treatment of chronic hepatitis B with YMDD mutation.