丙酚替诺福韦对比替诺福韦酯治疗HBeAg阳性乙肝患者的成本-效果分析

目的:对比丙酚替诺福韦和替诺福韦酯治疗HBeAg阳性乙肝患者的治疗效果和成本,进行成本-效果分析,优选治疗方案。方法:收集2020年1月至2021年12月石家庄市第五医院收治确诊为HBeAg阳性的慢性乙型肝炎、应用丙酚替诺福韦和替诺福韦酯进行抗病毒治疗的患者临床资料,筛选后共252例入组,根据使用药物分为丙酚替诺福韦组和替诺福韦酯组,规范治疗48周。对2组患者治疗48周时HBV-DNA阴转率进行统计分析,比较治疗效果;同时统计患者的治疗成本(药品费用、检查费用、住院费用),进行成本-效果分析,比较2组药物治疗的经济性。结果:2组患者在治疗48周时,治疗效果对比无统计学意义。治疗过程中,2组中重症患者的住院例数(占比)分别为16/29(55.17%)和11/38(28.95%),对比具有统计学意义(χ²=4.70,P=0.03)。在非住院患者中,成本-效果分析显示替诺福韦酯组优于丙酚替诺福韦组,增量成本-效果比为418.64;在住院患者中,成本-效果分析显示替诺福韦酯组劣于丙酚替诺福韦组,增量成本-效果比为-157.53。结论:2组药物的治疗效果无明显差异。对非住院治疗的患者来说,替诺福韦酯为优选方案,建议优先选用;但对于住院治疗的重症患者来说,建议选用丙酚替诺福韦以降低住院率,减轻患者经济负担。

Cost-effectiveness analysis of tenofovir alafenamide versus tenofovir dipivoxil fumarate in CHB patients with HBeAg-positive

OBJECTIVE The cost-effectiveness analysis of tenofovir alafenamide and tenofovir dipivoxil fumarate in the treatment of HBeAg-positivehepatitis B patients was analyzed,aiming to provide areference for clinical treatment.METHODS The clinical data of patients diagnosed with HBeAg-positivehepatitis B and treated with tenofovir alafenamide and tenofovir dipivoxil from January 2020 to December 2021 were collected.A total of 252 patients were included in the study,which were divided into tenofovir alafenamide group(TAF group)and tenofovir dipivoxil group(TDF group).After 48 weeks of treatment,the HBV-DNA negative conversion rate between two groups was compared.Meanwhile,the treatment costs(drug cost,inspection cost,hospitalization cost)was calculated,and the cost-effectiveness analysis was carried out.RESULTS There was no significant difference in treatment effect between the two groups at 48 weeks of treatment.During the treatment,the hospitalization rates in the two groups were 16/29(55.17%)and 11/38(28.95%)respectively,with statistical significance(χ²=4.70,P=0.03).In non-hospitalized patients,the cost-effectiveness analysis showed that the TDF group was better than the TAF group,and the incremental cost-effectiveness ratio was 418.64.In hospitalized patients,the cost-effectiveness analysis showed that the TDF group was inferior to the TAF group,and the incremental cost-effectiveness ratio was -157.53.CONCLUSIONS There was no significant difference in the therapeutic effect between the two groups.For non-hospitalized patients,TDF was the preferred choice.For critically ill patients,it is recommended to use tenofovir alafenamide to reduced the hospitalization rate and the financial burden of patients.