4种抗病毒方案治疗慢性乙型肝炎的经济学评价

目的:比较4种抗病毒方案治疗慢性乙型肝炎的经济学效果,寻找经济、有效的慢性乙型肝炎治疗方案。方法:采用回顾性调查方法,将接受抗病毒治疗的慢性乙型肝炎患者253例分为拉米夫定(LVD)组64例、阿德福韦酯(ADV)组64例、恩替卡韦(ETV)组63例和替比夫定(TBV)组62例,分别统计4组患者用药48周时的HBV-DNA阴转、HBeAg阴转和丙氨酸氨基转移酶(ALT)复常情况,统计用药金额,并进行经济学评价。结果:在HBV-DNA阴转率方面,TBV组与ETV组比较差异无统计学意义(P>0.05),但均优于LVD组和ADV组(P<0.05);在HBeAg阴转率和ALT复常率方面,组间比较差异无统计学意义(P>0.05)。以HBV-DNA阴转率为效果指标采用成本-效果分析,LVD组、ADV组、ETV组、TBV组的成本-效果比(C/E)分别为10721、12527、15851、10090,TBV组的C/E均低于其他3组;每增加1例HBV-DNA阴转患者,ADV组、ETV组、TBV组的增量成本-效果比(ΔC/ΔE)分别为31128、23132、9092,TBV组的ΔC/ΔE远低于ADV组和ETV组。以HBeAg阴转率和ALT复常率为效果指标采用最小成本分析,LVD组、ADV组、ETV组、TBV组的成本分别为5189、6652、13077、7971元,LVD组的成本均低于其他3组。结论:替比夫定治疗慢性乙型肝炎是较为经济、有效的抗病毒治疗方案。

Pharmacoeconomics Evaluation of 4 Therapeutic Schemes for Chronic Hepatitis B

OBJECTIVE： To compare pharmacoeconomics of 4 therapeutic scheme for chronic hepatitis B （CHB）, and to find out economical and effective one. METHODS： By retrospective study, 253 patients with CHB were divided into 64 cases in lamivudine （LVD） group, 64 cases in adetbvir （ADV） group, 63 cases in entecavir （ETV） group and 62 cases in telbivudine （TBV） group. HBV-DNA negative conversion, HBeAg negative conversion and ALT recovery were analyzed statistically in 4 groups after 48 weeks of treatment; the amount of drug use was analyzed statistically, and pharmacoeconomics evaluation was conducted. RESULTS： In the HBV-DNA negative-conversion rate, there were no significant differences between TBV group and ETV group （P〉 0.0.5）, but tile two groups were superior to LVD group and ADV group （P〈0.05）. In HBeAg negative-conversion rate and ALT normalization rate. there were no signi..qcant differences among 4 groups （P〉0.05）. Based on cost-effectiveness analysis using HBV-DNA negative-conversion rate as index, the costffectiveness ratios （C/E） of LVD group, ADV group, ETV group and TBV group were 10 721, 12 .527. 15 851 and 10 090 respectively, and that of TBV group was lower than other 3 groups： the incremental cost-effectiveness ratios （AC/AE） of group ADV group, ETV group and TBV group were 31 128, 23 132 and 9 092 as increas- ing a HBV-DNA negative-conversion patient, and that of TBV group was lower than ADV group and ETV group. Based on cost-minimization analysis, the cost for HBeAg negative-conversion rate and ALT normalization rate of LVD group, ADV group, ETV group and TBV group were 5 189 yuan, 6 652 yuan, 13 077 yuan and 7 971 yuan respectively, and that of LVD group was lower than other groups. CONCLUSIONS： TBV is more economical and effective for anti-HBV therapeutical scheme for CHB.