Faisal M Sanai, Mohammed Aljawad, Abdullah Saeed Alghamdi, Alon Yehoshua, Abdullah Khathlan, Mohammed Alghamdi, Sam Kozma, Nathaniel Smith, Fadoua El-Moustaid, Sushanth Jeyakumar, Nandita Kachru
{"title":"沙特阿拉伯低水平病毒血症慢性乙型肝炎患者转用替诺福韦-阿拉非那胺与继续服用恩替卡韦的长期健康和经济效益。","authors":"Faisal M Sanai, Mohammed Aljawad, Abdullah Saeed Alghamdi, Alon Yehoshua, Abdullah Khathlan, Mohammed Alghamdi, Sam Kozma, Nathaniel Smith, Fadoua El-Moustaid, Sushanth Jeyakumar, Nandita Kachru","doi":"10.4103/sjg.sjg_170_23","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Despite the success of current treatments, many chronic hepatitis B (CHB) patients still live with low-level viremia [LLV] resulting in liver disease progression. This study evaluated the long-term health and economic impact of switching to tenofovir alafenamide (TAF) from entecavir (ETV) in Saudi Arabia (SA) in chronic hepatitis B (CHB) LLV patients.</p><p><strong>Methods: </strong>A hybrid decision tree Markov state-transition model was developed to simulate a cohort of patients with CHB LLV treated with ETV and switched to TAF over a lifetime horizon in SA. While on treatment, patients either achieved complete virologic response (CVR) or maintained LLV. CVR patients experienced slower progression to advanced liver disease stages as compared to LLV patients. Demographic data, transition probabilities, treatment efficacy, health state costs, and utilities were sourced from published literature. Treatment costs were sourced from publicly available databases.</p><p><strong>Results: </strong>Base case analysis found that over a lifetime horizon, switching to TAF versus remaining on ETV increased the proportion of patients achieving CVR (76% versus 14%, respectively). Switching to TAF versus remaining on ETV resulted in a reduction in cases of compensated cirrhosis (-52%), decompensated cirrhosis (-5%), hepatocellular carcinoma (-22%), liver transplants (-12%), and a 37% reduction in liver-related deaths. Switching to TAF was cost-effective with an incremental cost-effectiveness ratio of $57,222, assuming a willingness-to-pay threshold of three times gross national income per capita [$65,790/QALY].</p><p><strong>Conclusions: </strong>This model found that switching to TAF versus remaining on ETV in SA CHB LLV patients substantially reduced long-term CHB-related morbidity and mortality and was a cost-effective treatment strategy.</p>","PeriodicalId":1,"journal":{"name":"Accounts of Chemical Research","volume":null,"pages":null},"PeriodicalIF":16.4000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852144/pdf/","citationCount":"0","resultStr":"{\"title\":\"Long-term health and economic benefits of switching to tenofovir alafenamide versus continuing on entecavir in chronic hepatitis B patients with low-level viremia in Saudi Arabia.\",\"authors\":\"Faisal M Sanai, Mohammed Aljawad, Abdullah Saeed Alghamdi, Alon Yehoshua, Abdullah Khathlan, Mohammed Alghamdi, Sam Kozma, Nathaniel Smith, Fadoua El-Moustaid, Sushanth Jeyakumar, Nandita Kachru\",\"doi\":\"10.4103/sjg.sjg_170_23\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Despite the success of current treatments, many chronic hepatitis B (CHB) patients still live with low-level viremia [LLV] resulting in liver disease progression. This study evaluated the long-term health and economic impact of switching to tenofovir alafenamide (TAF) from entecavir (ETV) in Saudi Arabia (SA) in chronic hepatitis B (CHB) LLV patients.</p><p><strong>Methods: </strong>A hybrid decision tree Markov state-transition model was developed to simulate a cohort of patients with CHB LLV treated with ETV and switched to TAF over a lifetime horizon in SA. While on treatment, patients either achieved complete virologic response (CVR) or maintained LLV. CVR patients experienced slower progression to advanced liver disease stages as compared to LLV patients. Demographic data, transition probabilities, treatment efficacy, health state costs, and utilities were sourced from published literature. Treatment costs were sourced from publicly available databases.</p><p><strong>Results: </strong>Base case analysis found that over a lifetime horizon, switching to TAF versus remaining on ETV increased the proportion of patients achieving CVR (76% versus 14%, respectively). Switching to TAF versus remaining on ETV resulted in a reduction in cases of compensated cirrhosis (-52%), decompensated cirrhosis (-5%), hepatocellular carcinoma (-22%), liver transplants (-12%), and a 37% reduction in liver-related deaths. Switching to TAF was cost-effective with an incremental cost-effectiveness ratio of $57,222, assuming a willingness-to-pay threshold of three times gross national income per capita [$65,790/QALY].</p><p><strong>Conclusions: </strong>This model found that switching to TAF versus remaining on ETV in SA CHB LLV patients substantially reduced long-term CHB-related morbidity and mortality and was a cost-effective treatment strategy.</p>\",\"PeriodicalId\":1,\"journal\":{\"name\":\"Accounts of Chemical Research\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":16.4000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852144/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Accounts of Chemical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4103/sjg.sjg_170_23\",\"RegionNum\":1,\"RegionCategory\":\"化学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/6/30 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CHEMISTRY, MULTIDISCIPLINARY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Accounts of Chemical Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/sjg.sjg_170_23","RegionNum":1,"RegionCategory":"化学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/6/30 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CHEMISTRY, MULTIDISCIPLINARY","Score":null,"Total":0}
引用次数: 0
摘要
背景:尽管目前的治疗取得了成功,但许多慢性乙型肝炎(CHB)患者仍然生活在低水平病毒血症[LLV]中,导致肝病恶化。本研究评估了沙特阿拉伯(SA)慢性乙型肝炎(CHB)低水平病毒血症患者从恩替卡韦(ETV)转为替诺福韦-阿拉非那胺(TAF)的长期健康和经济影响:方法:建立了一个混合决策树马尔可夫状态转换模型,以模拟在沙特接受 ETV 治疗并转为 TAF 治疗的慢性乙型肝炎 LLV 患者队列。在治疗期间,患者要么获得完全病毒学应答(CVR),要么维持 LLV。与 LLV 患者相比,CVR 患者肝病进展到晚期的速度较慢。人口统计学数据、转归概率、疗效、健康状态成本和效用均来自公开发表的文献。治疗成本来自公开数据库:基础病例分析发现,在整个生命周期内,转用 TAF 与继续使用 ETV 相比,实现 CVR 的患者比例有所提高(分别为 76% 与 14%)。改用 TAF 与继续服用 ETV 相比,代偿期肝硬化(-52%)、失代偿期肝硬化(-5%)、肝细胞癌(-22%)、肝移植(-12%)病例减少,肝脏相关死亡病例减少 37%。假设支付意愿阈值为人均国民总收入的三倍[65,790美元/QALY],则改用TAF具有成本效益,增量成本效益比为57,222美元:该模型发现,SA CHB LLV 患者改用 TAF 与继续使用 ETV 相比,可大幅降低 CHB 相关的长期发病率和死亡率,是一种具有成本效益的治疗策略。
Long-term health and economic benefits of switching to tenofovir alafenamide versus continuing on entecavir in chronic hepatitis B patients with low-level viremia in Saudi Arabia.
Background: Despite the success of current treatments, many chronic hepatitis B (CHB) patients still live with low-level viremia [LLV] resulting in liver disease progression. This study evaluated the long-term health and economic impact of switching to tenofovir alafenamide (TAF) from entecavir (ETV) in Saudi Arabia (SA) in chronic hepatitis B (CHB) LLV patients.
Methods: A hybrid decision tree Markov state-transition model was developed to simulate a cohort of patients with CHB LLV treated with ETV and switched to TAF over a lifetime horizon in SA. While on treatment, patients either achieved complete virologic response (CVR) or maintained LLV. CVR patients experienced slower progression to advanced liver disease stages as compared to LLV patients. Demographic data, transition probabilities, treatment efficacy, health state costs, and utilities were sourced from published literature. Treatment costs were sourced from publicly available databases.
Results: Base case analysis found that over a lifetime horizon, switching to TAF versus remaining on ETV increased the proportion of patients achieving CVR (76% versus 14%, respectively). Switching to TAF versus remaining on ETV resulted in a reduction in cases of compensated cirrhosis (-52%), decompensated cirrhosis (-5%), hepatocellular carcinoma (-22%), liver transplants (-12%), and a 37% reduction in liver-related deaths. Switching to TAF was cost-effective with an incremental cost-effectiveness ratio of $57,222, assuming a willingness-to-pay threshold of three times gross national income per capita [$65,790/QALY].
Conclusions: This model found that switching to TAF versus remaining on ETV in SA CHB LLV patients substantially reduced long-term CHB-related morbidity and mortality and was a cost-effective treatment strategy.
期刊介绍:
Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance.
Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.