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针对艾滋病毒/艾滋病的第一线治疗,INSTIs为中心的抗病毒疗法:一个网络元分析和成本效益分析

Jian Yang^1,2,3, Xuejuan Zhao^1,2,4, Fan Li^5,6,7

¹School of Pharmaceutical Sciences & Yunnan Provincial Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, Yunnan, 650500, People's Republic of China.

BMC infectious diseases

|April 25, 2025

概括

基于整合酶抑制剂治疗艾滋病毒/艾滋病的方案与中国的标准治疗一样有效和安全. 虽然这些方案对患者来说具有成本效益,但对医疗保健系统来说并非具有成本效益.

科学领域:

传染性疾病传染性疾病
药物经济学药物经济学
公共卫生公共卫生

背景情况:

在中国,艾滋病毒/艾滋病的第一线治疗依赖于 efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/3TC/TDF).
集成酶链转移抑制剂 (INSTIs) 是一种具有潜在益处的新型抗逆转录病毒疗法.

研究的目的:

为了比较基于INSTI的治疗方案的疗效,安全性和成本效益与中国HIV/AIDS治疗的国家标准EFV/3TC/TDF.
为临床决策提供信息,并优化艾滋病毒/艾滋病管理策略.

主要方法:

进行了随机对照试验的网络元分析.
使用马尔科夫模型进行的成本效益分析评估了比克特格拉维尔/埃姆特里西塔宾/诺福维尔阿拉芬胺 (B/F/TAF) 治疗方案与EFV/3TC/TDF.
测量结果包括质量调整寿命年 (QALY) 和增量成本效益比 (ICER).

主要成果:

INSTI疗法的疗效和安全性与EFV / 3TC / TDF相比,具有优越的耐药性,坚持性和生活质量.
从患者的角度来看,B/F/TAF是具有成本效益的 (ICER: $12,714.29/QALY),但从医疗保健系统的角度来看却不是 (ICER: $23,052.77/QALY).
敏感性分析确定了药物成本和CD4计数增加的可能性作为关键影响因素.

结论:

基于INSTI的疗法在中国的HIV/AIDS治疗国家标准上具有临床优势,特别是在控制耐药性和改善患者服药性方面.
虽然在经济上对患者来说是可行的,但从医疗保健系统的角度来看,INSTI疗法的成本效益需要进一步考虑.
将临床效益与经济影响相平衡,对于选择最佳的第一线艾滋病毒/艾滋病疗法至关重要.

关键词:

成本效益分析的成本效益分析艾滋病毒/艾滋病治疗治疗医疗保健资源的分配基于INSTI的治疗方案网络元分析网络元分析

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