Pharmacoeconomic Evaluation Of Decompensated Chronic Hepatitis B Fibrosis Based On Net Benefit Regression Framework

ObjectivesBased on the patient's perspective,a retrospective pharmacoeconomic study of two drug treatment options(group A:Chinese patent medicine A combined with entecavir dispersible tablets;group B:Chinese patent medicine B combined with entecavir dispersible tablets)for patients diagnosed as decompensated period of chronic hepatitis B liver fibrosis in a third-class A-level hospital in Beijing.In this study,two models of Chinese patent medicine combined with antiviral drugs for the treatment of decompensation period of chronic hepatitis B liver fibrosis were constructed.This study is based on case study data derived from non-randomized controls,and uses the net benefit regression framework model to eliminate the differences and uncertainties between different treatment options between groups.The two groups were analyzed when the population sociology and disease characteristics of the baseline were uneven.In this study,through the use of the net benefit regression analysis method,combined with the multiple linear regression in statistical analysis,the net benefit of the two groups of different treatment options was analyzed.In order to compare the economics of Chinese patent medicine A combined with entecavir dispersible tablets and Chinese patent medicine B combined with entecavir dispersible tablets.This study hopes to provide evidence-based reference for patients with chronic hepatitis B liver fibrosis decompensated period to choose cost-effective treatment options,and to provide reference for the rational use and distribution of medical resources in the field of decompensated period of chronic hepatitis B fibrosis medicine,and to provide decision-makers with the basis for drug selection and pricing decisions.MethodsIn this study,a literature research method was used to carry out a comprehensive and detailed search and literature collation of relevant documents since the establislunent of multiple Chinese and English literature databases according to the retrieval strategy to determine the clinical features,common clinical medications,and clinical efficacy evaluation indicators of decompensated period of chronic hepatitis B fibrosis.The expert consultation method was used to formulate the inclusion and exclusion criteria for case extraction and the selection strategy of drug programs.This study uses epidemiological research methods to obtain retrospective research data such as total cost of treatment and health output and conduct cost-effectiveness analysis.In this study,the econometric method was adopted,introducing the willingness to pay value(?),taking the net benefit as the dependent variable,taking the efficacy index as the independent variable,and using two groups of patient population sociology and disease characteristics variables and other variables as covariates to build a net benefit regression framework model.In this study,the net benefit regression analysis and sensitivity analysis are carried out based on the model that has been constructed.Contents1.This study conducted case screening and data extraction on the data of inpatients in the first liver cirrhosis treatment center of the hospital since the establishment of the information system of a third-class A-level hospital in Beijing until December 2018.The sociological baseline indicators,cost indicators,and efficacy indicators of patients with decompensated period chronic hepatitis B fibrosis were sorted into EpiData,and check whether the two groups of patients have consistent sociological baseline indicator levels,and to quantify treatment cost index and curative effect index.2.The cost-effectiveness analysis and sensitivity analysis of were performed on the changes of alanine aminotransferase(ALT)indexes and the normalization rate effect of alanine aminotransferase(ALT)before and after treatment in two groups of patients with decompensated period of chronic hepatitis B liver fibrosis using Chinese patent medicine A combined with entecavir dispersible tablets and Chinese patent medicine B combined with entecavir dispersible tablets.3.This study determines the covariates that need to be included in the regression model and builds a suitable net benefit regression framework.4.Based on the established net benefit regression framework,this study conducted a net benefit regression analysis of the two Chinese patent medicines combined with antiviral treatments in the treatment of decompensated period of chronic hepatitis B fibrosis,so as to compare the economics of the two groups of different treatment options under the net benefit regression framework model.5.According to the net benefit regression framework,this study conducted a sensitivity analysis on the willingness to pay value(?)of patients from low to high,and analyzed the threshold of willingness to pay for patients with decompensated period of chronic hepatitis B fibrosis by two Chinese patent medicines combined with antiviral treatment.6.The study analyzes the credibility of the decision of the two treatment options and draws the overall acceptable curve based on the credibility analysis results.Results1.Baseline situation:The statistical analysis of the general demographic baseline data of the two groups of patients showed that there was no statistically significant difference in gender between the two groups of patients(P>0.05),and there were significant differences in age and length of hospital stay(P<0.05).The baseline of the demographic data of the patients in the treatment group is uneven.The statistical analysis of the baseline data of the general disease characteristics of the two groups of patients showed that the two groups of patients had albumin(ALB),globulin(GLB),direct bilirubin(Dbil),total bilirubin(Tbil),aspartame There were significant differences in acid aminotransferase(AST),alkaline phosphatase(ALP)and cholinesterase(CHE)indicators(P<0.05),and there was no significant difference in glutamic acid transferase(GGT)indicators(P>0.05),the disease characteristics of the patients in the two treatment groups are not uniform in baseline.2.The clinical efficacy evaluation results:The treatment effect of the two groups of patients is evaluated with ALT as the index.The overall ALT index of the patients in the group A after treatment has decreased significantly,and the overall ALT index of the patients in the group B after treatment increased slightly,and the difference was statistically significant(P<0.05).The total effective rate of treatment in the two groups was evaluated by the index of ALT normalization rate,and the total effective rate of treatment in group A higher than group B,the difference is statistically significant(P<0.05).3.Non-model pharmacoeconomic evaluation results:The average cost of patients in group A(26617.70±17875.12yuan)is higher than that in group B(20393.76±1 1878.60yuan),the difference is statistically significant(P<0.05).Cost-effectiveness analysis showed that the cost-effectiveness ratio of the treatment plan in group A was 313.50,and the cost-effectiveness ratio of the treatment plan in group B was 305.91.The incremental cost-effect analysis results show that the ICER value is 341.24.Sensitivity analysis shows that the above conclusions are stable.4.Pharmacoeconomic evaluation based on the net benefit regression model:Due to the inconsistency of the baseline of the demographics and disease characteristics of the two groups of programs,all the confounding factors of population sociology and disease characteristics are used as covariates.taking net benefit as independent variable and effect index as dependent variable,introducing patient's willingness to pay value(?).constructing a net benefit regression model,the analysis results show that if the patient's maximum willingness to pay value(?)is greater than 31156.831 yuan,the net benefit of the treatment plan of group A is greater;if the patient's maximum willingness to pay should be less than 31156.831 yuan,the net benefit of the treatment plan of group B is greater.5.A sensitivity analysis of the patient's willingness to pay value(?)shows that When 0<?<9760,you can be confident(credibility is more than 90%)that the treatment plan of group B is more economical.when 9760<?<31156.831,you can be confident that the treatment plan of group B is more economical,but it is not very certain(credibility is less than 90%).When 31156.831<?<52300,it can be considered that the treatment plan of group A is more economical,but it is not very certain(credibility is less than 90%).when ?>5230,we can be more confident(credibility is more than 90%)that the treatment plan of group A is more economical.ConclusionsThe results of the analysis of the effects of the two treatment programs show that if the decrease in the value of alanine aminotransferase(ALT)is used as the index of effect,it can be considered that the treatment effect of group A is better.If the alanine aminotransferase(ALT)normalization rate is the index of total treatment efficiency,the total treatment efficiency of group A is higher.The cost-effectiveness analysis results in the non-model state show that the cost-effectiveness ratio of Group A is 313.50,and the cost-effectiveness ratio of Group B is 305.91.Incremental cost-effect analysis showed that each additional ALT normalization rate in Group A would cost an additional 341.24 yuan.The analysis results of the two groups of patients in the state of the net benefit regression model show that due to the confounding factors such as the population sociology and disease characteristics of the patients and the impact of the maximum willingness to pay value(?)on the net benefit,with the patient's maximum willingness to pay value(?)gradually Increased,the net benefits of the treatment programs in groups A and B also changed accordingly,the net benefits of patients in group A gradually increased,and the net benefits of patients in group B gradually decreased.If the patient's willingness to pay(?)is 31156.831 yuan,the net benefit of the two groups of patients can be considered equal.Therefore,for patients with a low maximum willingness to pay(?),it is more economical to choose a combination of Chinese patent medicine B and entecavir dispersible tablet.For patients with a higher maximum willingness to pay(?),it is more economical to choose Chinese patent medicine A combined with entecavir dispersible tablets.