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研究生:范綺萍
研究生(外文):Chi-Ping Fan
論文名稱:臺灣地區e抗原陽性慢性B型肝炎患者使用Telbivudine治療之成本效用分析
論文名稱(外文):Cost-Effectiveness Analysis of Telbivudine Therapy for HBeAg-positive Chronic Hepatitis B Patients in Taiwan
指導教授:蒲若芳蒲若芳引用關係
指導教授(外文):Raoh-Fang Pwu
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:89
中文關鍵詞:慢性B型肝炎e抗原陽性馬可夫模式成本效益
外文關鍵詞:Chronic hepatitis Bhepatitis B e antigen positivetelbivudinedecision analytic modelscost-effectiveness
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  • 被引用被引用:0
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  • 下載下載:3
  • 收藏至我的研究室書目清單書目收藏:2
研究背景與目的:B型肝炎病毒感染(Hepatitis B virus, HBV)為臺灣很重要的健康議題。臺灣每年B型肝炎帶原率為15-20%,屬盛行率高的國家之一。慢性B型肝炎所導致病程惡化至肝硬化及肝癌將為國人健康帶來莫大影響,但若慢性B型肝炎患者能被有效被照護積極接受治療,則可避免病患者病程演變至嚴重階段,不僅對病患與家屬有益,對減輕整體社會經濟負擔也有正面意義。近期Liaw(2008)臨床研究發現在療效終點定義為HBV DNA小於100,000copies/mL下,e抗原陽性慢性B型肝炎使用telbivudine治療後,無論是在HBV DNA抑制、肝功能正常化與肝組織改善,會比使用lamivudine治療療效更好。雖然臨床療效已被證實,其成本效益尚未被評估。因此,本研究目的在於探討e抗原陽性慢性B型肝炎患者使用telbivudine治療的成本效益。
材料與方法:本研究以健保局觀點,使用臺灣慢性B型肝炎患者治療之臨床醫學參數及相關治療成本,並透過決策分析模式對e抗原陽性慢性B型肝炎病患進行模擬,探討接受不同治療方案之成本效用分析。電腦模擬模式以1年為一個循環週期,模擬終點追蹤直到虛擬族群中所有病患均死亡為止,評估計算相關成本、品質校正生活年、終身健康照護成本及效用。主要三個評估治療方案包括(一)未使用任何抗病毒藥物。(二)使用lamivudine治療2年。(三)使用telbivudine治療2年。研究最終以品質校正生活年作為終生照護之效用指標,成本及效用折現3%,並對模式參數進行單維敏感度分析以了解結果之不確定性。
結果:將e抗原陽性病患使用telbivudine 2年與未接受任何抗病毒治療方案相比較結果發現使用telbivudine終生健康照護成本NT$323,921,未接受任何抗病毒治療終生健康照護成本NT$231,826,使用telbivudine治療會增加NT$92,095。然而,在使用telbivudine治療後會比增加3.99 QALYs。另外,比較e抗原陽性慢性B型肝炎病患使用telbivudine 2年與用lamivudine治療2年之結果發現,使用telbivudine終生健康照護成本NT$323,921,較使用lamivudine高NT$35,929,但使用telbivudine治療後會比lamivudine治療多0.83QALYs,其遞增成本效益比為NT$43,225/QALY。
結論:從本研究之結果顯示,雖然使用telbivudine治療兩年之終生照護成本預期較使用lamivudine多35,929元,但使用telbivudine之後可多獲得0.83QALYs,其遞增成本效益比為NT$43,225/QALY,顯示具成本效益。
Background and Objective: Chronic hepatitis B (CHB) infection is an important public health problem in Taiwan.The carrier rate of hepatitis B surface antigen (HBsAg) is as high as 15% to 20% in Taiwan, one of the highest in the world. Patients with chronic HBV infection are at risk of developing cirrhosis or hepatocellular carcinoma (HCC). Once CHB patients get suitable treatment, the progression to further sequalae could be stopped. The benefits would not be only to the individual, but to the society as a whole. A recent study found that telbivudine is more effective than lamivudine in treating hepatitisB e antigen (HBeAg)-positive CHB patients, but its cost-effectiveness has not been evaluated. The aim of this study was to estimate the cost-effectiveness of telbivudine therapy for HBeAg–positive CHB patients in Taiwan.
Methods: We conducted a cost-effectiveness analysis by building a decision analytic model. This study adopted the National Health Insurance perspective. The analysis considered a lifetime horizon. A hypothetical population with HBeAg-positive CHB with mean age of 32 was simulated. Disease progression probabilities, treatment effectiveness, costs and quality-of-life data were obtained from published literature and a phase III Globe clinical trial. We assumed a treatment duration of 2 years. The strategies included in the model are: 1) no antivial therapy; 2) lamivudine treatment for 24 months; 3) telbivudine treatment for 24 months. Quality-adjusted life years, lifetime costs, and incremental cost-effectiveness ratios (ICERs) were estimated. Costs and benefits were discounted at 3% per annum.
Result: In the group of patients with HBeAg-positive chronic hepatitis, telbivudine treatment for 24 months group was the most effective yet the most expensive, compared with no antivial therapy group and lamivudine treatment for 24 months group. The cost of using telbivudine average lifetime was evaluated to be NT$323,921 while the cost for patients with no antivial therapy was evaluated to be NT$231,826. Although telbivudine therapy was more expensive than no antivial therapy, it could slow the disease progression. After adjustment for quality of life in the various HBV-related health status, patients using telbivudine treatment gain 21.31QALYs and patients not receiveing antivial therapy gain 17.32 QALYs. The gain in quality-adjusted life-years (QALYs) for patients using telbivudine treatment was 0.83 QALYs with an additional cost of 35,929 NTD, compared to patients with lamivudine treatment. Using telbivudine treatment cost an incremental NT$ 43,225 per quality-adjusted life year (QALY) gained.
Conclusion: In Taiwan, treatment of HBeAg-positive CHB patients, 24 weeks of telbivudine sequential antiviral therapies may be highly cost-effectiveness. Treatment with telbivudine may bring to much effectiveness in health care systems with limited resources, especially in those serving population with a high prevalence of HBeAg-positive CHB patients.
致謝 i
中文摘要 i
Abstract i
目錄 III
表目次 VI
圖目次 VII
附錄目次 IX
第一章 緒論 1
第一節 研究背景 1
一、慢性B型肝炎概況 1
二、慢性B型肝炎治療的現況 3
第二節 研究動機與重要性 5
第三節 研究目的 6
第二章 文獻探討 7
第一節 慢性B型肝炎疾病病程簡介 7
一、慢性B型肝炎疾病的臨床表現 7
第二節 慢性B型肝炎藥物治療 10
一、慢性B型肝炎治療的準則 10
二、使用Lamivudine治療慢性B型肝炎 12
三、使用Telbivudine治療慢性B型肝炎 13
第三節 成本效用分析 15
第四節 電腦模擬分析 17
一、決策分析 17
第四節 電腦模擬應用於B型肝炎藥物治療之經濟評估 20
一、慢性B型肝炎藥物治療的成本效用分析 20
第三章 材料與方法 28
第一節 經濟評估 28
一、慢性B型肝炎治療決策模式之架構 28
二、目標族群及治療方案 29
第二節 資料來源 33
一、研究模式之參數及參數來源 33
二、結果之測量 33
三、成本之計算 33
四、生命表 34
五、成本效益評估指標 35
六、敏感度分析 35
第三節 研究假設 50
第四章 研究結果 52
第一節 決策模型預測各方案B型肝炎疾病發生個數 52
第二節 e抗原陽性慢性B型肝炎病患基本方案分析結果 53
第二節 敏感度分析之結果 62
第五章 討論與建議 73
第一節 重要結果與討論 73
第二節 研究限制 76
第六章 結論 78
參考文獻 79
中文部分 79
英文部分 80
附錄 85
中文部分
行政院衛生署(2007),醫療費用支付標準查詢-衛生統計系列(一)死因統計。線上檢索日期:2008年2月10日。網址: http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=9598&class_no=440&level_no=4。
台灣藥物經濟暨效果研究學會 (2006)。 建立台灣藥物經濟研究的相關評估指南 (Guildeines of Methodological Standards for Pharmacoeconomic Evalutaions) 。線上檢索日期:2009年6月30日。網址: http://www.taspor.org/wp-content/uploads/2007/12/2006pe_guidelines.pdf。
林志陵,、高嘉宏(2009)。 肝癌危險因子和流行病學之變遷。 當代醫學, 36(1), 25-32。
莊善安 (2000)。 慢性B型肝炎的藥物治療。 台灣醫學, 4(5), 575-579。
陳昭姿 (2007)。Telbivudine(sebivo)-B型肝炎治療又見新藥。 當代醫學, 34(12), 938-941。
曾光毅、曾嵩智 (2004)。 現階段B型肝炎的預防與治療。 基層醫學, 19(1), 19-25。
黃奕文、高嘉宏 (2008)。 人類白血球抗原多型性與B型肝炎病毒感染臨床病程之相關性。 當代醫學, 35(5), 344-349。
楊培銘 (1998)。 慢性B型肝炎之治療。 台灣醫學, 2(6), 654-660。
廖運範 (2003)。 慢性B型肝炎(二)處置與治療。 當代醫學, 30(3), 173-181。
廖運範 (2006)。 慢性B型肝炎治療新貌。當代醫學, 33(5), 353-365。
廖運範 (2007)。 慢性B型肝炎治療的難題:抗藥性突變。當代醫學, 34(2), 90-96。
蕭宗賢、李宜謙、蘇東弘、高嘉宏 (2008)。 B型肝炎治療之新進展。當代醫學,35(7), 517-530。



英文部分
Amarapurkar, D. N. (2007). Telbivudine: A new treatment for chronic hepatitis B. [Review]. World Journal of Gastroenterology, 13(46), 6150-6155.
Anna, S. F., Lok, A. S. F., & McMahon, B. J. (2007). Corrections to AASLD guidelines on chronic hepatitis B. Hepatology, 45(6), 1347.
Briggs, A. H. (2000). Handling uncertainty in cost-effectiveness models. PharmacoEconomics, 17(5), 479-500.
Brooks, E. A., Lacey, L. F., Payne, S. L., & Miller, D. W. (2001). Economic evaluation of lamivudine compared with interferon-α in the treatment of chronic hepatitis B in the United States. American Journal of Managed Care, 7(7), 677-682.
Chan, H. L. Y., & Sung, J. J. Y. (2006). Hepatocellular carcinoma and hepatitis B virus. Seminars in Liver Disease, 26(2), 153-161.
Chang, T. T., Lai, C. L., Chien, R. N., Guan, R., Lim, S. G., Lee, C. M., et al. (2004). Four years of lamivudine treatment in Chinese patients with chronic hepatitis B. Journal of Gastroenterology and Hepatology, 19(11), 1276-1282.
Chen, C. J., Yang, H. I., Su, J., Jen, C. L., You, S. L., Lu, S. N., et al. (2006). Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. Jama-Journal of the American Medical Association, 295(1), 65-73.
Chen, C. L., Fan, S. T., Lee, S. G., Makuuchi, M., & Tanaka, K. (2003). Living-donor liver transplantation: 12 Years of experience in Asia. Transplantation, 75(3 SUPPL.), S6-S11.
Chu, C. M., Hung, S. J., Lin, J., Tai, D. I., & Liaw, Y. F. (2004). Natural history of hepatitis B e antigen to antibody seroconversion in patients with normal serum aminotransferase levels. American Journal of Medicine, 116(12), 829-834.
Chu, C. M., & Liaw, Y. F. (2005). Genotype C hepatitis B virus infection is associated with a higher risk of reactivation of hepatitis B and progression to cirrhosis than genotype B: A longitudinal study of hepatitis B e antigen-positive patients with normal aminotransferase levels at baseline. Journal of Hepatology, 43(3), 411-417.
Dan, Y. Y., & Lim, S. G. (2007). Applicability of cost-effectiveness analysis to management of chronic hepatitis B. Journal of Gastroenterology and Hepatology, 22(9), 1357-1359.
Dienstag, J. L., Schiff, E. R., Wright, T. L., Perrillo, R. P., Hann, H. W. L., Goodman, Z., et al. (1999). Lamivudine as initial treatment for chronic hepatitis B in the United States. New England Journal of Medicine, 341(17), 1256-1263.
Drummond, M. F. (2006). Economic evaluation. Singapore Medical Jourana 47(6), 456-462.
Drummond, M. F., O''Brien, B., Stoddart, G. L., & Torrance, G. W. (1998). Methods for the Economic Evaluation of Health Care Programmes, Second Edition. American Journal of Preventive Medicine, 14(3), 243.
Elsevier, B. V. (2009). EASL Clinical Practice Guidelines: Management of chronic hepatitis B. Paper presented at the Journal of Hepatology. from www.elsevier.com/locate/jhep
Fattovich, G., Stroffolini, T., Zagni, I., & Donato, F. (2004). Hepatocellular carcinoma in cirrhosis: Incidence and risk factors. Gastroenterology, 127(SUPPL.), S35-S50.
Feld, J. J., Ayers, M., El-Ashry, D., Mazzulli, T., Tellier, R., & Heathcote, E. J. (2007). Hepatitis B virus DNA prediction rules for hepatitis B e antigen-negative chronic hepatitis B. Hepatology, 46(4), 1057-1070.
Gish, R. G., & Locarnini, S. A. (2006). Chronic Hepatitis B: Current Testing Strategies. Clinical Gastroenterology and Hepatology, 4(6), 666-676.
Hou, J., Liu, Z., & Gu, F. (2005). Epidemiology and prevention of hepatitis B virus infection. International Journal of Medical Sciences, 2(1), 50-57.
Huo, T. L., Wu, J. C., Hwang, S. J., Lai, C. R., Lee, P. C., Tsay, S. H., et al. (2000). Factors predictive of liver cirrhosis in patients with chronic hepatitis B: A multivariate analysis in a longitudinal study. European Journal of Gastroenterology and Hepatology, 12(6), 687-693.
Iloeje, U. H., Yang, H. I., Su, J., Jen, C. L., You, S. L., & Chen, C. J. (2006). Predicting cirrhosis risk based on the level of circulating hepatitis B viral load. Gastroenterology, 130(3), 678-686.
Jones, R., & Nelson, M. (2006). Novel anti-hepatitis B agents: A focus on telbivudine. International Journal of Clinical Practice, 60(10), 1295-1299.
Kanwal, F., Gralnek, I. M., Martin, P., Dulai, G. S., Farid, M., & Spiegel, B. M. R. (2005). Treatment alternatives for chronic hepatitis B virus infection: A cost-effectiveness analysis. Annals of Internal Medicine, 142(10), 821-831.
Lacey, L., Chien, R. N., Chuang, W. L., & Pwu, R. F. (2008). Economic evaluation of chronic hepatitis B treatments in Taiwan. Journal of Gastroenterology and Hepatology, 23(4), 571-579.
Lacey, L., & Cooksley, G. (2004). Review of economic benefits of treating chronic hepatitis B with lamivudine. Journal of Gastroenterology and Hepatology, 19(SUPPL.), S10-S12.
Lai, C. L., Chien, R. N., Leung, N. W. Y., Chang, T. T., Guan, R., Tai, D. I., et al. (1998). A one-year trial of lamivudine for chronic hepatitis B. New England Journal of Medicine, 339(2), 61-68.
Lai, C. L., Gane, E., Liaw, Y. F., Hsu, C. W., Thongsawat, S., Wang, Y., et al. (2007). Telbivudine versus lamivudine in patients with chronic hepatitis B. New England Journal of Medicine, 357(25), 2576-2588.
Lai, C. L., Leung, N., Teo, E. K., Tong, M., Wong, F., Hann, H. W., et al. (2005). A 1-year trial of telbivudine, lamivudine, and the combination in patients with hepatitis B e antigen-positive chronic hepatitis B. Gastroenterology, 129(2), 528-536.
Liaw, Y. F. (2009). Natural history of chronic hepatitis B virus infection and long-term outcome under treatment. Liver International, 29(SUPPL. 1), 100-107.
Liaw, Y. F., Gane, E., Leung, N., Zeuzem, S., Wang, Y., Lai, C. L., et al. (2009). 2-Year GLOBE Trial Results: Telbivudine Is Superior to Lamivudine in Patients With Chronic Hepatitis B. Gastroenterology, 136(2), 486-495.
Liaw, Y. F., Gane, E., Leung, N., Zeuzem, S., Wang, Y., Lai, C. L., et al. (2008). 2-Year GLOBE Trial Results: Telbivudine Is Superior to Lamivudine in
Patients With Chronic Hepatitis B. GASTROENTEROLOGY.
Liaw, Y. F., Leung, N., Guan, R., Lau, G. K. K., Merican, I., McCaughan, G., et al. (2005). Asian-Pacific consensus statement on the management of chronic hepatitis B: A 2005 update. Liver International, 25(3), 472-489.
Liaw, Y. F., Leung, N., Kao, J. H., Piratvisuth, T., Gane, E., Han, K. H., et al. (2008). Asian-Pacific consensus statement on the management of chronic hepatitis B: A 2008 update. Hepatology International, 2(3), 263-283.
Liaw, Y. F., Lin, D. Y., Chen, T. J., & Chu, C. M. (1989). Natural course after the development of cirrhosis in patients with chronic type B hepatitis: A prospective study. Liver, 9(4), 235-241.
Liaw, Y. F., Sung, J. J. Y., Chow, W. C., Farrell, G., Lee, C. Z., Yuen, H., et al. (2004). Lamivudine for patients with chronic hepatitis B and advanced liver disease. New England Journal of Medicine, 351(15), 1521-1531+1587.
Liaw, Y. F., Tai, D. I., Chu, C. M., & Chen, T. J. (1988). The development of cirrhosis in patients with chronic type B hepatitis: A prospective study. Hepatology, 8(3), 493-496.
Lin, T. M., Tsu, W. T., & Chen, C. J. (1986). Mortality of hepatoma and cirrhosis of liver in Taiwan. British Journal of Cancer, 54(6), 969-976.
Lok, A. S. F., & McMahon, B. J. (2007). Chronic hepatitis B. Hepatology, 45(2), 507-539.
Loka, & McMahon, B. J. (2007). The most recent guidelines for the management of chronic hepatitis B
Muennig, P., & Khan, K. (2002). Designing and conducting cost-effectiveness analyses in medicine and health care. San Franciso: Jossey-Bass.
Muller, C. J. (2008). Telbivudine (Sebivo). Telbivudin - Handelsname: Sebivo (D, A, CH), 48(4), 853-858.
Naimark, D., Krahn, M. D., Naglie, G., Redelmeier, D. A., & Detsky, A. S. (1997). Primer on medical decision analysis: Part 5 - Working with Markov processes. Medical Decision Making, 17(2), 152-159.
Orlewska, E. (2002). The cost-effectiveness of alternative therapeutic strategies for the management of chronic hepatitis B in Poland. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 5(5), 404-420.
Pwu, R. F. (2007). Cost-effectiveness analysis of telbivudine therapy in the treatment of chronic hepatitis B in Taiwan.
Pwu, R. F., & Chan, K. A. (2002). Cost-effectiveness analysis of interferon-alpha therapy in the treatment of chronic hepatitis B in Taiwan. Journal of the Formosan Medical Association, 101(9), 632-641.
Rajendra, A., & Wong, J. B. (2007). Economics of chronic hepatitis B and hepatitis C. Journal of Hepatology, 47(4), 608-617.
Sonnenberg, F. A., & Beck, J. R. (1993). Markov models in medical decision making: A practical guide. Medical Decision Making, 13(4), 322-338.
Spackman, D. E., & Veenstra, D. L. (2008). A cost-effectiveness analysis of currently approved treatments for HBeAg-positive chronic hepatitis B. PharmacoEconomics, 26(11), 937-949.
Sun, X., & Faunce, T. (2008). Decision-analytical modelling in health-care economic evaluations. European Journal of Health Economics, 9(4), 313-323.
Veenstra, D. L., Sullivan, S. D., Lai, M. Y., Lee, C. M., Tsai, C. M., & Patel, K. K. (2008). HBeAg-Negative Chronic Hepatitis B: Cost-Effectiveness of Peginterferon Alfa-2a Compared to Lamivudine in Taiwan. Value in Health, 11(2), 131-138.
Weinstein, M. C., O''Brien, B., Hornberger, J., Jackson, J., Johannesson, M., McCabe, C., et al. (2003). Principles of good practice for decision analytic modeling in health-care evaluation: Report of the ISPOR task force on good research practices - Modeling studies. Value in Health, 6(1), 9-17.
Weinstein, M. C., & Stason, W. B. (1977). Foundations of cost effectiveness analysis for health and medical practices. New England Journal of Medicine, 296(13), 716-721.
Wong, J. B., Koff, R. S., Tine, F., & Pauker, S. G. (1995). Cost-effectiveness of interferon-α2b treatment for hepatitis B e antigen- positive chronic hepatitis B. Annals of Internal Medicine, 122(9), 664-675.
Wong, J. B., & Pauker, S. G. (2007). Cost-effectiveness of telbivudine versus lamivudine for chronic hepatitis B.
Wong, J. B., & Pomfret, T. (2007). Pharmacologic management of chronic hepatitis B. Formulary, 42(7), 429-438.
Yang, H. I., Lu, S. N., Liaw, Y. F., You, S. L., Sun, C. A., Wang, L. Y., et al. (2002). Hepatitis B e antigen and the risk of hepatocellular carcinoma. New England Journal of Medicine, 347(3), 168-174.
Yang, P. M. (1998). Treatment of Chronic Hepatitis B. Formosan J Med, 2(6), 654-660.
Yuen, M. F. (2007). Revisiting the natural history of chronic hepatitis B: Impact of new concepts on clinical management. Journal of Gastroenterology and Hepatology, 22(7), 973-976.
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1. 林志陵,、高嘉宏(2009)。 肝癌危險因子和流行病學之變遷。 當代醫學, 36(1), 25-32。
2. 林志陵,、高嘉宏(2009)。 肝癌危險因子和流行病學之變遷。 當代醫學, 36(1), 25-32。
3. 陳昭姿 (2007)。Telbivudine(sebivo)-B型肝炎治療又見新藥。 當代醫學, 34(12), 938-941。
4. 陳昭姿 (2007)。Telbivudine(sebivo)-B型肝炎治療又見新藥。 當代醫學, 34(12), 938-941。
5. 曾光毅、曾嵩智 (2004)。 現階段B型肝炎的預防與治療。 基層醫學, 19(1), 19-25。
6. 曾光毅、曾嵩智 (2004)。 現階段B型肝炎的預防與治療。 基層醫學, 19(1), 19-25。
7. 黃奕文、高嘉宏 (2008)。 人類白血球抗原多型性與B型肝炎病毒感染臨床病程之相關性。 當代醫學, 35(5), 344-349。
8. 黃奕文、高嘉宏 (2008)。 人類白血球抗原多型性與B型肝炎病毒感染臨床病程之相關性。 當代醫學, 35(5), 344-349。
9. 廖運範 (2003)。 慢性B型肝炎(二)處置與治療。 當代醫學, 30(3), 173-181。
10. 廖運範 (2003)。 慢性B型肝炎(二)處置與治療。 當代醫學, 30(3), 173-181。
11. 廖運範 (2006)。 慢性B型肝炎治療新貌。當代醫學, 33(5), 353-365。
12. 廖運範 (2006)。 慢性B型肝炎治療新貌。當代醫學, 33(5), 353-365。
13. 廖運範 (2007)。 慢性B型肝炎治療的難題:抗藥性突變。當代醫學, 34(2), 90-96。
14. 廖運範 (2007)。 慢性B型肝炎治療的難題:抗藥性突變。當代醫學, 34(2), 90-96。
15. 蕭宗賢、李宜謙、蘇東弘、高嘉宏 (2008)。 B型肝炎治療之新進展。當代醫學,35(7), 517-530。