背景:使用直接作用剂(DAA)根除丙型肝炎病毒(HCV)与全球卫生当局的经济负担有关。我们旨在从巴西卫生部(BMoH)的角度评估DAA基于指南的治疗费用。
方法:基于活动的成本计算方法用于通过以下策略评估基因型1(GT1)HCV患者的监测/治疗成本:聚乙二醇干扰素(PEG-IFN)/利巴韦林(RBV)48周,PEG-IFN/RBV加boceprevir(BOC)或telaprevir(TEL)48周,和sofosbuvir(SOF)加daclastavir(DCV)或simeprevir(SIM)12周。费用以美元报告,没有(美元),有购买力平价调整(购买力平价)。在国家健康价格数据库中收集药物成本,并对文献进行了概述,以评估实际队列中SOF/DCV和SOF/SIM方案的有效性。
结果:对于PEG-IFN/RBV,GT1-HCV患者的治疗费用为PPP$43,176.28(US$24,020.16),PEG-IFN/RBV/BOC的购买力平价为71,196.03美元(39,578.23美元),PEG-IFN/RBV/TEL的购买力平价为86,250.33美元(47,946.92美元)。通过全口服无干扰素方案治疗是较便宜的方法:SOF/DCV的购买力平价为19,761.72美元(10,985.90美元),SOF/SIM的购买力平价为21,590.91美元(12,002.75美元)。概述报道了HCV根除率对于SOF/DCV高达98%,对于SOF/SIM高达96%。
结论:在巴西,与基于IFN的方案相比,所有口服不含干扰素的策略可能会降低GT1-HCV患者的治疗成本。发生这种情况的主要原因是,由于BMoH与制药行业之间的谈判,国际DAA价格的折扣很高。
BACKGROUND: Eradication of hepatitis C virus (HCV) using direct-acting agents (DAA) has been associated with a financial burden to health authorities worldwide. We aimed to evaluate the
guideline-based treatment costs by DAAs from the perspective of the Brazilian Ministry of Health (BMoH).
METHODS: The activity based costing method was used to estimate the cost for monitoring/treatment of genotype-1 (GT1) HCV patients by the following strategies: peg-interferon (PEG-IFN)/ribavirin (RBV) for 48 weeks, PEG-IFN/RBV plus boceprevir (BOC) or telaprevir (TEL) for 48 weeks, and
sofosbuvir (SOF) plus daclastavir (DCV) or simeprevir (SIM) for 12 weeks. Costs were reported in United States Dollars without (US$) and with adjustment for purchasing power parity (PPP$). Drug costs were collected at the National Database of Health Prices and an overview of the literature was performed to assess effectiveness of SOF/DCV and SOF/SIM regimens in real-world cohorts.
RESULTS: Treatment costs of GT1-HCV patients were PPP$ 43,176.28 (US$ 24,020.16) for PEG-IFN/RBV, PPP$ 71,196.03 (US$ 39,578.23) for PEG-IFN/RBV/BOC and PPP$ 86,250.33 (US$ 47,946.92) for PEG-IFN/RBV/TEL. Treatment by all-oral interferon-free regimens were the less expensive approach: PPP$ 19,761.72 (US$ 10,985.90) for SOF/DCV and PPP$ 21,590.91 (US$ 12,002.75) for SOF/SIM. The overview reported HCV eradication in up to 98% for SOF/DCV and 96% for SOF/SIM.
CONCLUSIONS: Strategies with all oral interferon-free might lead to lower costs for management of GT1-HCV patients compared to IFN-based regimens in Brazil. This occurred mainly because of high discounts over international DAA prices due to negotiation between BMoH and pharmaceutical industries.