替比夫定和拉米夫定治疗e抗原阳性和阴性慢性乙型肝炎的药物经济学评价

目的 对替比夫定和拉米夫定治疗e抗原阳性和阴性慢性乙型肝炎进行药物经济学评价.方法 基于医疗保险角度开展药物经济学评价研究.依据慢性乙型肝炎的疾病进展规律,构建Markov模型,以GLOBE 2年临床试验结果为主要资料来源.另收集不同乙型肝炎相关疾病状态下的年医疗费用和生活质量评分情况.以增量成本效果比作为评价指标,并对分析结果进行灵敏度分析.结果 与拉米夫定相比,替比夫定治疗HBeAg阳性慢性乙型肝炎患者每延长1个质量调整生命年(QALY)多需的医疗费用在北京和广州分别为5403元、4916元.治疗HBeAg阴性慢性乙型肝炎患者的增量成本效果比在两地分别为28 239元/QALY和29 618元/QALY.根据文献报道的全国乙型肝炎相关疾病经济负担,与拉米夫定相比,替比夫定治疗HBeAg阳性和阴性慢性乙型肝炎患者每延长1个质量调整生命年多需的医疗费用分别为1282元和31 565元.结论 按世界卫生组织建议标准,替比夫定较拉米夫定治疗HBeAg阳性和阴性慢性乙型肝炎更具成本效果.

Pharmacoeconomic evaluation of telbivudine vs.lamivudine in treating the patients with HBeAg-positive and negative chronic hepatitis B

Objective To evaluate long-term cost effectiveness of telbivudine and lamivudine for the treatment of CHB.Methods Cost effectiveness was conducted from social health insurance perspective.A Markov model was established based on disease progression pattern and the data from the 2 years GLOBE clinical trial.The information of annual medical expenditure and quality-of-life assessment for different CHB related diseases was obtained from literature.Incremental cost per life year or quality-adjusted life year gained was measured.Results Compared with lamivudine,the incremental cost for 1 additional QALY gained with telbivudine in treating HBeAg-positive and -negative CHB were 5403 yuan and 28 239 yuan in Beijing,as well 4916 yuan and 29 618 yuan in Guangzhou,respectively.According to national economic burden of CHB-related diseases,the ICER with telbivudine vs lamivudine were 1282 yuan and 31565 yuan for HBeAg-positive and -negative CHB.Conclusion According to WHO recommendation for ICER threshold,telbivudine is cost effective in treating HBeAg-positive and -negative CHB,as compared to lamivudine.