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目的从中国医疗系统的角度,对HBeAg阴性慢性乙型肝炎(乙肝)短期和长期抗病毒治疗方案进行经济学评价。方法建立包含10个健康状态的Markov模型,估计不同方案治疗HBeAg阴性慢性乙肝患者的长期效果和费用,并进行增量分析。结果与非抗病毒治疗比较,最具成本效果的短期治疗方案是拉米夫定治疗1年;拉米夫定治疗必要时换用阿德福韦,或阿德福韦治疗必要时换用拉米夫定作为挽救治疗5年,可更持续地延缓疾病进展。与拉米夫定治疗1年比较,最具成本效果的长期治疗方案是拉米夫定+阿德福韦,或阿德福韦+拉米夫定作为挽救治疗5年,每单位质量调整生命年(QALY)的增量费用分别为16 465元和17 884元,分别比国际阈值的中国估值低70.6%和68.1%。结论HBeAg阴性慢性乙肝短期治疗方案中,拉米夫定比恩替卡韦、聚乙二醇干扰素α-2a和非抗病毒治疗更具成本效果;长期治疗方案中,拉米夫定加阿德福韦或阿德福韦加拉米夫定挽救治疗均具有成本效果。
Objective To evaluate the short-term and long-term antiviral treatment of HBeAg-negative chronic hepatitis B (hepatitis B) from the perspective of Chinese medical system. Methods A Markov model with 10 healthy states was established to evaluate the long-term effects and costs of different regimens in the treatment of patients with HBeAg-negative chronic hepatitis B and to conduct an incremental analysis. Results Compared with non-antiviral treatment, the most cost-effective short-term regimen was lamivudine for 1 year, lamivudine for adefovir when necessary, or adefovir for treatment if necessary Mifradin, as a rescue treatment for 5 years, can delay the progression of the disease more sustainably. Compared with 1 year of lamivudine treatment, the most cost-effective long-term treatment regimen is lamivudine plus adefovir or adefovir + lamivudine for 5 years as a rescue treatment and life-changing per unit mass (QALY) incremental fees of 16,465 yuan and 17,884 yuan respectively, which are respectively 70.6% and 68.1% lower than the international threshold of China’s valuation. Conclusions Among the short-term HBeAg-negative chronic hepatitis B regimens, lamivudine, entecavir, peginterferon alfa-2a and non-antiviral therapy are more cost-effective. In long-term treatment regimens, lamivudine plus adefovir Or adefovir plus lamivudine rescue treatment are cost-effective.