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Am J Transplant:肾移植前还是移植后进行HCV治疗又好又省钱?

2018-11-25 吴星 环球医学

现已存在获批用于终末期肾病(ESRD)的直接作用的抗病毒药物(DAA)。HCV阳性(HCV+)的ESRD患者现有机会通过接受HCV感染的肾脏而降低移植等待时间。肾移植候选人中,HCV治疗的最佳时机(移植前vs移植后)未知。2018年10月,发表在《Am J Transplant》的一项研究调查了,肾移植前vs移植后HCV治疗的人群水平结局和成本效果。

现已存在获批用于终末期肾病(ESRD)的直接作用的抗病毒药物(DAA)。HCV阳性(HCV+)的ESRD患者现有机会通过接受HCV感染的肾脏而降低移植等待时间。肾移植候选人中,HCV治疗的最佳时机(移植前vs移植后)未知。2018年10月,发表在《Am J Transplant》的一项研究调查了,肾移植前vs移植后HCV治疗的人群水平结局和成本效果。

使用获批用于ESRD患者的2种方案,Monte Carlo模拟100000名候选人,用于确定生命周期内不同肝纤维化阶段和等待时间,移植前vs移植后HCV治疗的成本效果。

与移植后治疗相比,在除了F0期病毒性肝炎的组织学数据的Meta分析(移植前vs移植后:5.7 vs 5.8QALYs)外的所有亚组中,移植前治疗可产生更高的质量调整生命年(QALYs)。然而,移植后治疗因使用了HCV感染的肾脏而降低了透析时间,从而节省成本(移植前vs移植后:$735700 vs $682400)。使用$100000的支付意愿阈值,除了纤维化进展停止的F3期病毒性肝炎的组织学数据的Meta分析外,移植前治疗不具成本效果。如果HCV+移植候选人能够得到HCV感染供者的肾脏,并肾脏移植早于HCV阴性候选人≥9个月,那么移植前治疗不再具有成本效果(增量成本效果比(ICER):$107100)。

总之,最佳治疗时机取决于纤维化分期和HCV+肾脏的可及性,但是一般倾向于移植后HCV根除。

原始出处:

Shelton BA, Sawinski D, Linas BP, et al. Population level outcomes and cost-effectiveness of hepatitis C treatment pre- vs postkidney transplantation. Am J Transplant. 2018 Oct;18(10):2483-2495. doi: 10.1111/ajt.15040.

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    2019-02-01 智慧医人
  2. [GetPortalCommentsPageByObjectIdResponse(id=1657104, encodeId=f9e5165e10476, content=<a href='/topic/show?id=3ca31e71903' target=_blank style='color:#2F92EE;'>#TRA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17719, encryptionId=3ca31e71903, topicName=TRA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a12645, createdName=智慧医人, createdTime=Fri Feb 01 15:44:00 CST 2019, time=2019-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1789215, encodeId=a7cb1e89215ff, content=<a href='/topic/show?id=0c8814344f5' target=_blank style='color:#2F92EE;'>#plant#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14344, encryptionId=0c8814344f5, topicName=plant)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8f5b299, createdName=xuyu, createdTime=Fri Apr 19 02:44:00 CST 2019, time=2019-04-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1796148, encodeId=e92a1e961486b, content=<a href='/topic/show?id=691c1e765a0' target=_blank style='color:#2F92EE;'>#Transplant#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=92, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17765, encryptionId=691c1e765a0, topicName=Transplant)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=232a2500033, createdName=1249859em38(暂无昵称), createdTime=Sat Mar 09 10:44:00 CST 2019, time=2019-03-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1257760, encodeId=2fe1125e760e8, content=<a href='/topic/show?id=774e856e22' target=_blank style='color:#2F92EE;'>#HCV#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8567, encryptionId=774e856e22, topicName=HCV)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=460849, createdName=ymljack, createdTime=Tue Nov 27 00:44:00 CST 2018, time=2018-11-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=353614, encodeId=c3ac3536145c, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=82311653708, createdName=医者仁心5538, createdTime=Sun Nov 25 09:57:00 CST 2018, time=2018-11-25, status=1, ipAttribution=)]
    2019-04-19 xuyu
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    2018-11-27 ymljack
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    2018-11-25 医者仁心5538

    学习了

    0

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