聚乙二醇干扰素α-2a治疗慢性丙型肝炎的不良反应观察

目的观察聚乙二醇干扰素α-2a治疗慢性丙型肝炎的不良反应,探讨有效的处理措施。方法回顾性分析我院2011年1月～2012年1月收治的38例慢性丙型肝炎患者的临床资料,所有患者均给予聚乙二醇干扰素α-2a治疗,观察患者治疗期间的不良反应。结果本组38例患者治疗期间流感样症状发生率最高,为68.4%,患者主要表现为发热、鼻塞、关节肌肉痛,其次脱发的发生率为47.4%。肝功能损害、骨髓抑制反应、神经系统症状、皮疹的发生率分别为39.5%、28.9%、15.8%、7.9%。结论聚乙二醇干扰素α-2a治疗慢性丙型肝炎的不良反应较多,应引起临床医师的足够重视,一旦发生不良反应应迅速给予有效的对症处理,保证用药安全。     

重组人干扰素α-2b注射液联合恩替卡韦治疗乙型肝炎e抗原阳性慢性乙型肝炎患者的疗效观察

目的探讨重组人干扰素α-2b注射液联合恩替卡韦治疗乙型肝炎e抗原(HBe Ag)阳性慢性乙型肝炎患者的效果。方法收集48例慢性乙型肝炎患者资料,对患者使用重组人干扰素α-2b注射液联合恩替卡韦治疗,观察患者的病情变化情况。结果治疗24周后,完全应答25例,部分应答18例,无应答5例;治疗12周时,丙氨酸转氨酶(ALT)复常35例;治疗24周时,ALT复常46例。结论重组人干扰素α-2b注射液联合恩替卡韦治疗HBe Ag阳性慢性乙型肝炎效果明显。     

α-干扰素治疗丙型炎肝的疗效及其不良反应研究

目的探讨α-干扰素治疗丙型肝炎的疗效及不良反应。方法选取本院2011年1月至2013年1月收治的46例丙型肝炎患者,按不同年龄段划分四个组别,采取肌内注射α-干扰素进行治疗。结果经过α-干扰素治疗后,46例患者中,治愈13例,显效15例,8例出现恶化,10例未出现明显变化,α-干扰素治疗有效率61%。20~29岁组有效率为84%、30~39岁组有效率为76%、40~49岁组有效率为44%、50岁以上组有效率为27%。在治疗期间,有39例(85%)患者出现了流感样症状,40例(87%)患者出现了白细胞计数减少的症状,28例(61%)患者出现了间质性肺炎的症状,38例(83%)患者出现了神经精神症状,29例(63%)患者出现了消化道反应,16例(35%)患者出现了骨髓抑制,14例(30%)患者出现了一过性肝损害。结论α-干扰素治疗效果肯定,但不同年龄组α-干扰素治疗丙型肝炎疗效存在差异。干扰素治疗丙型肝炎中会出现多种不良反应,加强临床用药监测,积极预防并对症处理。     

干扰素联合炎琥宁治疗小儿手足口病的临床效果观察

目的分析研究干扰素联合炎琥宁治疗小儿手足口病的临床表现,观察临床中治疗效果。方法将来我院进行治疗小儿手足口病的150例患儿进行随机分配,分成A、B、C三组,各50例,A组50例患儿采用干扰素单一治疗;B组50例患儿采用炎琥宁的单一治疗;C组50例患儿采用干扰素联合炎琥宁治疗。通过对比三组患儿的退烧时间、口腔溃烂愈合时间、住院时间及用药后的疗效。结果单独用药的临床效果和临床表现相比较无明显差异;而联合用药与单独用药的临床效果和临床表现相对比有明显差异(P<0.05),具有统计学意义。结论干扰素联合炎琥宁治疗小儿手足口病的临床效果显著,是治疗小儿手足口病的最佳方法之一。     

基于Markov模型对泛基因型直接抗病毒药物治疗慢性丙型肝炎的药物经济学评价

目的 评价已在中国上市的泛基因型直接抗病毒药物(DAAs)治疗方案与聚乙二醇干扰素(Peg-IFN)为基础的治疗方案用于慢性丙型肝炎(CHC)患者的经济性。方法 从中国医疗卫生体系视角出发,以中国初治CHC患者为目标人群,构建Markov模型。分别模拟非肝硬化和代偿性肝硬化CHC患者在不同治疗方案下获得的质量调整生命年(QALYs)和所花费的直接医疗成本,并计算增量成本-效用比(ICUR)。采用敏感性分析验证结果的稳健性。结果 对于非肝硬化CHC患者,与传统的聚乙二醇干扰素联合利巴韦林(PR)方案比较,3种泛基因型DAAs方案均增加了QALYs而显著降低了终身医疗成本,均为绝对优势方案。对于代偿性肝硬化患者,索磷布韦/维帕他韦方案的QALYs最高而终身治疗成本最低,依然是绝对优势方案。格卡瑞韦/哌仑他韦和索磷布韦联合达拉他韦方案与传统PR方案比较,ICUR分别为3 106.09元/QALY和80 843.45元/QALY;前者小于本研究设定的意愿支付阈值70 892元/QALY(2019年我国人均国内生产总值(GDP)),后者明显小于2019年国内人均GDP的3倍(212676元/QALY)。因此与传统PR方案比较,格卡瑞韦/哌仑他韦和索磷布韦联合达拉他韦方案亦具有显著的药物经济学优势。敏感性分析结果验证了基础分析结果的稳健性。以最具经济学优势的索磷布韦/维帕他韦为对照方案,通过成本-效用分析和阈值分析,测算若格卡瑞韦/哌仑他韦和索磷布韦联合达拉他韦方案达到同等经济性,格卡瑞韦/哌仑他韦、索磷布韦和达拉他韦需分别降价80.5%、80.0%和82.3%。结论 对于非肝硬化和代偿性肝硬化CHC患者,所有泛基因型DAAs治疗方案均具有显著的药物经济学优势,其中索磷布韦/维帕他韦最具成本-效用优势。     

重组人干扰素α2a栓辅助治疗慢性宫颈炎合并人乳头瘤病毒感染患者的效果

目的 探讨重组人干扰素α2a栓辅助治疗慢性宫颈炎合并人乳头瘤病毒（HPV）感染患者的效果。方法 选取2018年7月至2020年12月西藏民族大学附属医院收治的121例慢性宫颈炎合并HPV感染患者作为研究对象,按照随机数字表法分为常规组（60例）与联合组（61例）。常规组予以电灼光治疗,联合组辅以重组人干扰素α2a栓治疗,比较两组宫颈一般状况、炎症因子[超敏C反应蛋白（hs-CRP）、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及白细胞介素-4(IL-4)]水平以及不良反应发生情况。结果 治疗3个月后联合组宫颈症状积分（3.34±0.36）分、HPV病毒载量（6.74±1.45）×103/ml均低于常规组（3.51±0.43）分、（7.42±1.57）×103/ml,联合组分泌物恢复时间（13.56±2.34）d、创面愈合时间（6.94±1.28）d均短于常规组（14.74±2.63）d、（7.53±1.34）d,差异有统计学意义（P<0.05）;治疗3个月后联合组hs-CRP(1.18±0.37)mg/L、IL-6(1.98±0.25)pg/L、TNF-α(34.7...     

LEEP刀联合α-干扰素栓治疗宫颈糜烂疗效观察

目的探讨LEEP刀联合α-干扰素栓治疗宫颈糜烂的临床疗效及优越性。方法将96例宫颈糜烂患者分为观察组（54例）和对照组（42例）,对照组给予LEEP治疗,观察组给予LEEP联合α-干扰素治疗,观察两组患者治疗效果。结果观察组术后出血持续时间、创面愈合时间均明显早于对照组（P＜0.05）;观察组治疗总有效率为98.15%,明显高于对照组的80.95%（P＜0.05）。结论 LEEP联合α-干扰素栓治疗宫颈糜烂疗效好、恢复快,值得临床推广应用。     

喜炎平联合利巴韦林治疗手足口病160例疗效观察

目的研究喜炎平联合巴韦林治疗手足口病的具体效果，为临床治疗提供必要的指导和借鉴。方法将160例手足口病患儿随机分为对照组和治疗组各80例，对照组患儿在采取常规治疗的基础上使用利巴韦林进行治疗，而治疗组在常规治疗的基础上采取喜炎平联合利巴韦林治疗。对两组患儿用药后的体征和临床症状进行观察分析，对治疗后的总有效率、患儿皮疹消退时间和退烧时间进行对比。结果治疗组的临床总有效率要明显高于对照组。在患儿体征和症状方面治疗组也明显优于对照组，两组比较其差异具有统计学意义。结论喜炎平联合利巴韦林治疗手足口病具有较好的临床效果，值得在临床上进行应用推广。     

利巴韦林泡腾颗粒剂的制备工艺改进

目的改进利巴韦林泡腾颗粒剂的生产工艺,优化泡腾颗粒剂的辅料及其配比。方法采用正交设计法,以PH值、粒度及融化时间作为评价指标,探讨柠檬酸与碳酸氢钠比例、甜蜜素和聚乙二醇6000用量对利巴韦林泡腾颗粒剂质量影响。结果利巴韦林泡腾颗粒剂最佳制备工艺:比例为1:1柠檬酸与碳酸氢钠,8%聚乙二醇6000和0.8%甜蜜素。结论采取最佳的制备工艺,可得最佳的利巴韦林泡腾颗粒剂。     

干扰素治疗乙型肝炎所致精神障碍的临床分析及护理对策

目的探讨干扰素治疗乙型肝炎所致精神障碍的临床分析及护理对策。方法选取2010年1月～2013年4月我院收治的50例慢性乙型肝炎抗病毒患者,均给予重组人工干扰素α-2b予以治疗,配合常规治疗观察用药后的反应。结果有30例患者注射干扰素后,精神状况良好无乏力、肌肉酸痛,食欲差等症状。10例患者仍主诉乏力、周身不适症状。用药1月后,10例患者上述症状无改善,仍有失眠、焦虑不安等症状,其中5例患者出现轻度抑郁等精神症状,经过精神科会诊,在抗病毒治疗的同时给予抗抑郁药物治疗,经2～3个月的治疗后抑郁、失眠状态好转,持续用药,2例患者抑郁症状较重、有自杀倾向、停用抗病毒药物治疗,转至精神科治疗。结论积极有效的全程干预,密切观察病情,及时掌握病情变化,采取有针对性的治疗护理措施,解除患者紧张恐惧心理,提高慢性乙型肝炎患者抗病毒治疗的依从性,达到控制病程进展,延长寿命,提高生活质量。     

Cost-effectiveness of daclatasvir plus sofosbuvir-based regimen for treatment of hepatitis C virus genotype 3 infection in Canada

Objective:

New regimens for the treatment of chronic hepatitis C virus (HCV) genotype 3 have demonstrated substantial improvement in sustained virologic response (SVR) compared with existing therapies, but are considerably more expensive. The objective of this study was to evaluate the cost-effectiveness of two novel all-oral, interferon-free regimens for the treatment of patients with HCV genotype 3: daclatasvir plus sofosbuvir (DCV?+?SOF) and sofosbuvir plus ribavirin (SOF?+?RBV), from a Canadian health-system perspective.

Methods:

A decision analytic Markov model was developed to compare the effect of various treatment strategies on the natural history of the disease and their associated costs in treatment-naïve and treatment-experienced patients. Patients were initially distributed across fibrosis stages F0–F4, and may incur disease progression through fibrosis stages and on to end-stage liver disease complications and death; or may achieve SVR. Clinical efficacy, health-related quality-of-life, costs, and transition probabilities were based on published literature. Probabilistic sensitivity analysis was performed to assess parameter uncertainty associated with the analysis.

Results:

In treatment-naive patients, the expected quality-adjusted life years (QALYs) for interferon-free regimens were higher for DCV?+?SOF (12.37) and SOF?+?RBV (12.48) compared to that of pINF?+?RBV (11.71) over a lifetime horizon, applying their clinical trial treatment durations. The expected costs were higher for DCV?+?SOF ($170,371) and SOF?+?RBV ($194,776) vs pINF?+?RBV regimen ($90,905). Compared to pINF?+?RBV, the incremental cost-effectiveness ratios (ICER) were $120,671 and $135,398 per QALYs for DCV?+?SOF and SOF?+?RBV, respectively. In treatment-experienced patients, DCV?+?SOF regimen dominated the SOF?+?RBV regimen. Probabilistic sensitivity analysis indicated a 100% probability that a DCV?+?SOF regimen was cost saving in treatment-experienced patients.

Conclusion:

Daclatasvir plus sofosbuvir is a safe and effective option for the treatment of chronic HCV genotype 3 patients. This regimen could be considered a cost-effective option following a first-line treatment of peg-interferon/ribavirin treatment experienced patients with HCV genotype-3 infection.     

Cost-effectiveness of currently recommended direct-acting antiviral treatments in patients infected with genotypes 1 or 4 hepatitis C virus in the US

Objective: This study compared the cost-effectiveness of direct-acting antiviral therapies currently recommended for treating genotypes (GT) 1 and 4 chronic hepatitis C (CHC) patients in the US.

Methods: A cost-effectiveness analysis of treatments for CHC from a US payer’s perspective over a lifelong time horizon was performed. A Markov model based on the natural history of CHC was used for a population that included treatment-naïve and -experienced patients. Treatment alternatives considered for GT1 included ombitasvir/paritaprevir/ritonavir?+?dasabuvir?±?ribavirin (3D?±?R), sofosbuvir?+?ledipasvir (SOF/LDV), sofosbuvir?+?simeprevir (SOF?+?SMV), simeprevir?+?pegylated interferon/ribavirin (SMV?+?PR) and no treatment (NT). For GT4 treatments, ombitasvir/paritaprevir/ritonavir?+?ribavirin (2D?+?R), SOF/LDV and NT were compared. Transition probabilities, utilities and costs were obtained from published literature. Outcomes included rates of compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC) and liver-related death (LrD), total costs, life-years and quality-adjusted life-years (QALYs). Costs and QALYs were used to calculate incremental cost-effectiveness ratios.

Results: In GT1 patients, 3D?±?R and SOF-containing regimens have similar long-term outcomes; 3D?±?R had the lowest lifetime risks of all liver disease outcomes: CC =?30.2%, DCC = 5.0?%, HCC = 6.8%, LT =?1.9% and LrD =?9.2%. In GT1 patients, 3D?±?R had the lowest cost and the highest QALYs. As a result, 3D?±?R dominated these treatment options. In GT4 patients, 2D?+?R had lower rates of liver morbidity and mortality, lower cost and more QALYs than SOF/LDV and NT.

Limitations: While the results are based on input values, which were obtained from a variety of heterogeneous sources—including clinical trials, the findings were robust across a plausible range of input values, as demonstrated in probabilistic sensitivity analyses.

Conclusions: Among currently recommended treatments for GT1 and GT4 in the US, 3D?±?R (for GT1) and 2D?+?R (for GT4) have a favorable cost-effectiveness profile.     

Impact of completing chronic hepatitis C (CHC) treatment on post-therapy healthcare cost

Background:

Chronic hepatitis C (CHC) is associated with significant economic burden. This study evaluated the healthcare cost alleviation associated with treatment of CHC.

Methods:

Health insurance claims from 60 self-insured US companies were analyzed (01/2001–03/2012). Adult patients with ≥1 CHC diagnosis (ICD-9-CM: 070.44, 070.54), initiating interferon, and with ≥2 dispensings and with ≥48 weeks of follow-up were selected. Patients diagnosed with HIV or who completed only 24 weeks of interferon therapy (a surrogate for CHC genotypes 2 and 3) were excluded from the study. Interferon users were categorized into complete and discontinued therapy cohorts. During the post–48-week treatment period, cohorts were compared for healthcare resource utilization using rate ratios (RRs), as well as healthcare costs using per-patient per-year (PPPY) cost differences.

Results:

A total of 1017 patients who completed and 953 patients who discontinued interferon therapy were identified. Relative to the discontinued therapy cohort, the completed therapy cohort had significantly fewer hospitalizations (RR [95% CI]?=?0.74 [0.68, 0.81], p?p?p?=?0.039), which translated into significantly lower total healthcare costs PPPY (cost difference [95% CI]?=?$4540 [1570, 7680], p?=?0.004) and hospitalization costs (cost difference [95% CI]?=?$3039 [1140, 5248], p?=?0.002). Non–CHC-related costs accounted for 55% and CHC-related costs for 45% of the all-cause cost difference between cohorts.

Limitations:

Claims data may have contained inaccuracies, and genotypes of patients with CHC could not be confirmed. The study consisted of privately insured individuals and may not be generalizable to the entire CHC population.

Conclusion:

Compared to discontinued therapy patients, CHC patients who completed interferon therapy and presumably had a higher rate of achieving SVR were found to have lower levels of healthcare resource utilization and costs post-therapy. The reduction was primarily in costs associated with non–HCV-related comorbidities.     

Medical resource utilization and costs among Australian patients with genotype 1 chronic hepatitis C: results of a retrospective observational study

Objective: To evaluate medical resource utilization (MRU) and associated costs among Australian patients with genotype 1 chronic hepatitis C (GT1 CHC), including both untreated patients and those receiving treatment with first-generation protease inhibitor-based regimens (telaprevir, boceprevir with pegylated interferon and ribavirin).

Methods: Medical records were reviewed for a stratified random sample of GT1 CHC patients first attending two liver clinics between 2011–2013 (principal population; PP), supplemented by all GT1 CHC patients attending one transplant clinic in the same period (transplant population; TP). CHC-related MRU and associated costs are reported for the PP by treatment status (treated/not treated) stratified by baseline fibrosis grade; and for the TP for the pre-transplant, year of transplant and post-transplant periods.

Results: A total 1636 patients were screened and 590 patients (36.1%) were included. Comprehensive MRU data were collected for 276 PP patients (F0–1 n?=?59, F2 n?=?58, F3 n?=?53, F4 n?=?106; mean follow-up?=?17.3 months). Thirty-eight (13.8%) were treatment-experienced prior to enrolment; 55 (19.9%) received triple therapy during the study. Data were collected for 112 TP patients (mean follow-up?=?29.9 months), 33 (29.5%) received a transplant during the study, and 51 (45.5%) beforehand. The annual direct medical costs, excluding drug costs, were higher among treated PP vs untreated PP (AU$: $1,954 vs $1,202); and year of transplant TP vs pre-/post-transplant TP (AU$: pre-transplant $32,407, transplant $155,138, post-transplant $7,358).

Limitations: To aid interpretation of results, note that only patients with GT1 CHC who are actively managed are included, and MRU data were collected specifically from liver outpatient clinics. That said, movement of patients between hospitals is rare, and any uncaptured MRU is expected to be minimal.

Conclusions: CHC-related MRU increases substantially with disease severity. These real-world MRU data for GT1 CHC will be valuable in assessing the impact of new hepatitis C treatments.     

Public health impact of comprehensive hepatitis C screening and treatment in the French baby-boomer population

Objective: To estimate the public health impact of comprehensive hepatitis C virus (HCV) screening and access to all-oral, interferon (IFN)-free direct-acting antivirals (DAAs) in the French baby-boomer population (1945–1965 birth cohorts).

Methods: A sequential, multi-cohort, health-state transition model was developed to assess the impact of different hepatitis C screening and treatment strategies on clinical and economic outcomes in the 1945–1965 birth cohorts. Patients newly-diagnosed with chronic HCV were projected each year from 2016 to 2036 under three screening scenarios (70% [low], 75% [intermediate], and 80% [high] HCV awareness in 2036). Healthcare costs and clinical outcomes (number of liver-related deaths, quality-adjusted life-years [QALYs], life-years [LYs] spent in sustained virologic response [SVR] or with decompensated cirrhosis, hepatocellular carcinoma, or liver transplant) were compared among five treatment strategies (no antiviral therapy; IFN?+?ribavirin?+?protease inhibitor for fibrosis stages F2–F4, IFN-based DAAs for stages F2–F4, IFN-free DAAs for stages F2–F4, and IFN-free DAAs for stages F0–F4).

Results: Diagnosis of HCV genotype 1 was projected for 4,953, 6,600, and 8,368 individuals in the low, intermediate, and high screening scenarios, respectively. In the intermediate scenario, IFN-free DAAs for stages F0–F4 had a favorable cost-effectiveness profile vs IFN-based or IFN-free treatment strategies for F2–F4 and offered the greatest return on investment (0.899 LYs gained in SVR and 0.933 QALYs per €10,000 invested).

Conclusion: Comprehensive HCV screening and access to all-oral, IFN-free DAAs is a cost-effective strategy that could help diminish the upcoming burden of HCV in the French baby-boomer population.     

Cost-effectiveness of sofosbuvir plus ribavirin with or without pegylated interferon for the treatment of chronic hepatitis C in Italy

Abstract

Objective:

Across Italy up to 7.3% of the population is infected with hepatitis C virus (HCV), with long-term complications resulting in high medical costs and significant morbidity and mortality. Current treatment options have limitations due to side effects, interferon intolerability and ineligibility, long treatment durations and low sustained virological response (SVR) rates, especially for the most severe patients). Sofosbuvir is the first nucleotide polymerase inhibitor with pan-genotypic activity. Sofosbuvir, administered with ribavirin (RBV) and with or without pegylated interferon (PEG-INF), resulted in >90% SVR across treatment-naïve (TN) genotype (GT) 1–6 patients. It is also the first treatment option for patients that are unsuitable for interferon (UI). This analysis evaluates the cost – effectiveness of sofosbuvir for GTs 1–6 in Italy.     

论“互联网+”商业模式专利保护的制度设计

“互联网+”商业模式日益成为我国市场经济发展的强劲发动机，有必要对其进行保护，而专利保护应作为主要方式。目前相关法律保护制度无法充分覆盖商业模式保护，需要重新进行制度设计。我国“互联网+”商业模式专利保护的制度设计，应坚持静态与动态相结合的总体观察视角，以利益的冲突、衡量与选择作为核心设计理念。具体而言，应以专利法律为主，配套政策文件为辅，构建商业模式知识创新与利用的整体政策体系；在商业模式专利审查范围扩大的情况下，应当严格专利审查标准，尤其是严格创造性标准的审查；采用特别保护制度进行辅助，比如短期专利制度等特别措施；建立商业模式专利人才体系培养机制，探寻商业模式专利保护的国际合作机制，坚定维护我国国家社会利益，促进经济社会整体发展与繁荣。     

全要素网络下技农贸一体化与“互联网+农业”可持续发展

转型升级与可持续发展是我国现代农业发展的战略目标。从农业生产中的全要素网络理论模型构建入手，分析全要素网络与技农贸一体化之间的关系，提出3种技农贸一体化模式，即“公司+农户”模式、家庭农场模式及农业电商模式，并对3种模式下要素整合能力进行比较分析。整合互联网技术与可持续发展理念，提出“互联网+农业”发展模式，并结合全要素网络理论，归纳出“互联网+农业”可持续发展的4条路径。最后，以“供销e家”为案例，阐述其全要素网络架构和技农贸一体化道路，并说明其对“互联网+农业”可持续发展的启示价值。研究结论对于探索中国农业现代化发展的本质、关系、规律及途径具有重要的理论意义和现实指导价值。     

Cost minimisation analysis of 12 or 24 weeks of peginterferon alfa-2b + ribavirin for hepatitis C virus

Abstract

Background: Pegylated interferon and ribavirin are at present the standard treatment for chronic hepatitis C virus (HCV) patients.

Objective: The present economic evaluation compared 12 vs. 24 weeks of peginterferon alfa-2b + ribavirin treatments for HCV genotypes 2 or 3. Shortening the period of antiviral therapy is important in terms of adverse events and costs.

Methods: Clinical evidence was based on the results of a multicentre, randomised controlled clinical trial (RCCT) conducted in Italy, which found that the shorter course of therapy was as effective as the 24-week course for patients with HCV genotypes 2 or 3 responding to treatment at 4 weeks. A cost minimisation analysis was performed. The analysis took the Italian National Health Service (INHS) point of view, thus only healthcare costs (drugs, medical consultations, diagnostic tests, hospital admissions) were considered. Healthcare activities were estimated by the RCCT principal investigators and were priced by applying the INHS tariffs and prices.

Results: The total mean cost per patient was estimated at €9,785 for the standard group and €7,508 for the variable-duration group. Sensitivity analysis confirmed the robustness of the baseline results.

Conclusions: This study showed that the variable-duration regimen can be recommended as an efficient use of resources for patients from the INHS perspective.     

Peginterferon beta-1a versus other self-injectable disease-modifying therapies in the treatment of relapsing-remitting multiple sclerosis in Scotland: a cost-effectiveness analysis

Aims: Peginterferon beta-1a 125?mcg administered subcutaneously every 2 weeks, a new disease-modifying therapy (DMT) for relapsing-remitting multiple sclerosis (RRMS), was approved in January 2015 by the Scottish Medicines Consortium. This study assesses long-term clinical and economic outcomes of peginterferon beta-1a compared with other self-injectable DMTs (interferon beta-1a [22?mcg, 30?mcg, and 44?mcg], interferon beta-1b, and glatiramer acetate 20?mg) in the treatment of RRMS, from the National Health Service and Personal Social Services perspective in Scotland.

Methods: A previously published, validated Markov cohort model was adapted for this analysis. The model estimates changes in patient disability, occurrence of relapses, and other adverse events, and translates them into quality-adjusted life years and costs. Natural history data came from the ADVANCE trial of peginterferon beta-1a, the London Ontario (Canada) database, and a large population-based MS survey in the UK. The comparative efficacy of each DMT vs placebo was obtained from a network meta-analysis. Costs (2015 British Pounds) were obtained from public databases and literature. Clinical and economic outcomes were projected over 30 years and discounted at 3.5% per year.

Results: Over 30 years, peginterferon beta-1a was dominant compared with interferon beta-1a (22, 30, and 44?mcg), and interferon beta-1b, and cost-effective compared with glatiramer acetate 20?mg. Results were most sensitive to variations in each DMT’s efficacy and acquisition costs. Deterministic and probabilistic sensitivity analyses confirmed the robustness of the results.

Limitations: The impact of improved adherence with peginterferon beta-1a on clinical and economic outcomes and the impact of subsequent DMTs after treatment discontinuation were not considered. Oral and infused DMTs were not included as comparators.

Conclusion Long-term treatment with peginterferon beta-1a improves clinical outcomes, while its cost profile makes it either dominant or cost-effective compared with other self-injectable DMTs for the treatment of RRMS in Scotland.