Custo-efetividade dos análogos de nucleosídeos/nucleotídeos para hepatite crônica B / Cost-effectiveness of nucleoside/nucleotide analogues in chronic hepatitis B / Costo-efectividad de los análogos de nucleósidos/nucleótidos para hepatitis crónica B
Rev. saúde pública
; 46(6): 942-949, Dez. 2012. ilus, graf, tab
Artigo
em Português
| LILACS
| ID: lil-667604
Biblioteca responsável:
BR1.1
RESUMO
.
ABSTRACT
OBJECTIVE:
To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB).METHODS:
Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg- negative) with a 40-year time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties.RESULTS:
Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine.CONCLUSIONS:
The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection.RESUMEN
.
Avaliación de Costo-Efectividad; Avaliação de Custo-Efetividade; Chronic; Cost-Effectiveness Evaluation; Drug effects; Efectos de drogas; Efeitos de drogas; Hepatite B Crônica; Hepatitis B Crónica; Hepatitis B vírus; Hepatitis B; Nucleosides; Nucleosídeos; Nucleósidos; Recidiva; Recurrence; Recurrencia; Terapia; Terapia; Therapeutic use; Therapy; Uso terapêutico; Uso terapêutico; Virus de la Hepatitis B; Vírus da Hepatite B
Texto completo:
Disponível
Coleções:
Bases de dados internacionais
Contexto em Saúde:
Agenda de Saúde Sustentável para as Américas
Problema de saúde:
Objetivo 4: Financiamento para a saúde
Base de dados:
LILACS
Assunto principal:
Antivirais
/
Hepatite B Crônica
/
Farmacorresistência Viral
Tipo de estudo:
Avaliação econômica em saúde
Aspecto:
Preferência do paciente
Limite:
Humanos
Idioma:
Português
Revista:
Rev. saúde pública
Assunto da revista:
Saúde Pública
Ano de publicação:
2012
Tipo de documento:
Artigo
/
Documento de projeto
País de afiliação:
Brasil
Instituição/País de afiliação:
Secretaria de Estado de Saúde/BR