3种方案治疗代偿期肝硬化YMDD变异患者的成本-效果分析

Cost–Effectiveness Analysis of 3 Therapeutic Schemes in Treatment of Posthepatitic Cirrhosis with YMDD Mutation

关键词:  肝硬化  YMDD变异  拉米夫定  阿德福韦酯  成本-效果分析

Key words:  posthepatitic cirrhosis  YMDD mutation  lamivudine  adefovir dipivoxil  cost-effect analysis

摘要:

目的 评价3种方案治疗代偿期乙型肝炎肝硬化YMDD变异患者的成本-效果。方法 将64例患者随机分为3组，A组采用阿德福韦酯(adefovir dipivoxil，ADV)(10 mg·d^-1)治疗48周，B组采用ADV(10 mg·d^-1)与拉米夫定(lamivudine，LAM)(100 mg·d-1)联合治疗12周，后单用ADV(10 mg·d^-1)治疗36周；C组采用ADV(10 mg·d^-1)与LAM(100 mg·d^-1)联合治疗48周。运用药物经济学方法分析其成本-效果。结果 A，B，C组丙氨酸氨基转移酶复常率成本-效果比分别为15 721.8，16 922.6，15 140.6；以A组为参照，B，C组增量成本-效果比为29 064.4，14 412.1。A，B，C组HBV-DNA转阴率成本-效果比分别为13 125.5，15 384.2，14 334.5；以A组为参照，B，C组增量成本-效果比为261 580.0，16 400.0。A，B，C组HBeAg/HBeAb转换率成本-效果比分别为43 092.8，4 943.5，57 873.8；以A组为参照，B，C组增量成本-效果比为108 992.0，108 991.7。A组出现rtA181V和rtN236T各1例，B组rtN236T变异1例。结论 ADV联合LAM治疗方案为代偿期乙型肝炎肝硬化YMDD变异患者较优选择。

Abstract:

OBJECTIVE To evaluate the cost-effect of 3 therapeutic schemes in treatment of posthepatitic cirrhosis with YMDD mutation. METHODS Sixty-four patients were randomly assigned into three groups. In A group, patients were administrated with adefovir dipivoxil (ADV) (10 mg·d^-1) for 48 weeks. In B group, patients were administrated with ADV(10 mg·d^-1) in combination with lamivudine (LAM) (100 mg·d^-1) during the first 12-week period and in the second period, all the patients were singly administrated with ADV (10 mg·d^-1) for 36 weeks. But in the C group, patients received ADV(10 mg·d^-1) in combination with LAM(100 mg·d^-1) for 48 weeks. The data were evaluated with cost-effectiveness analysis. RESULTS The three groups′cost-effectiveness ratios of serum alanine aminotransferase normalization rate were 15 721.8, 16 922.6, 15 140.6. As compared with group A, the incremental cost-effectiveness ratios of groups B and C were 29 064.4 and 14 412.1, respectively. The three groups′cost-effectiveness ratios of HBV-DNA negative rate were13 125.5，15 384.2，14 334.5. As compared with group A, the incremental cost-effectiveness ratios of groups B and C were 261 580.0 and 16 400.0, respectively. The three groups，cost-effectiveness ratios of HBeAg/HBeAb seroconversion rate were 43 092.8, 54 943.5, 57 873.8. As compared with group A, the incremental cost-effectiveness ratios of groups B and C were 108 992.0 and 108 991.7, respectively. One patient had rtN236T mutation and another one had rtA181V mutation after 48-week treatment in A group and one patient had rtN236T mutation in B group. CONCLUSION ADV in combination with LAM is more cost-effective in treatment of posthepatitic cirrhosis with YMDD mutation.