目的：对替比夫定优化方案与恩替卡韦方案治疗HBeAg 阳性慢性乙型肝炎进行药物经济学评价。方法：根据慢性乙型肝炎进展规律，构建含多个健康状态的Markov模型，以替比夫定单药方案作基准，估计替比夫定优化方案与恩替卡韦方案治疗 HBeAg 阳性慢性乙型肝炎患者的长期效果和医疗费用，并进行增量分析。结果：使用恩替卡韦方案使 HBeAg 阳性慢性乙型肝炎患者获得35．95年的期望生存年和22．94个质量调整生命年，其总费用为349279．27元，每延长1个质量调整生命年多需的医疗费用为15225．77元。使用替比夫定优化方案获得了长于恩替卡韦方案的36．11年的期望生存年和23．08个质量调整生命年，其总费用为348863．62元，每延长1个质量调整生命年多需的医疗费用为15115．41元，低于恩替卡韦方案的15225．77元。结论：使用替比夫定优化方案相比恩替卡韦方案具有略优的成本效果，可以作为临床上HBeAg阳性慢性乙型肝炎抗病毒治疗的较优选择。%Objective To compare the cost-effectiveness of telbivudine-based optimization treatment and entecavir monotherapy in patients with HBeAg-positive chronic hepatitis B (CHB). Methods A Markov model for disease progression of CHB was constructed and cost-effectiveness analysis was conducted to estimate their long-term effects and medical costs. Results There were 36.11 expected life years (ELYs) and 23.08 quality adjusted life years (QALYs) gained from treatment with telbivudine optimization, which were longer than 35.95 ELYs and 23.08 QALYs from entecavir treatment. The total cost of telbivudine optimization was 348 863.62 yuan and that of entecavir treatment 349 279.27 yuan. Each extension of a QALYs required for medical expenses of 15 115.41 yuan in telvivudine optimization, which was cheaper than that in entecavir treatment with 15 225.77 yuan. Conclusions Telbivudine-based optimization treatment shows good cost-effectiveness than entecavir monotherapy. Telbivudine-based optimization treatment can be used as the optimum choice for antiviral therapy in CHB.
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