Supplementary Material for: Cost-Effectiveness of IL28Β Genotype-Guided Protease Inhibitor Triple Therapy versus Standard of Care Treatment in Patients with Hepatitis C Genotypes 2 or 3 Infection

Background/Aims: Triple therapy [adding protease inhibitors to standard of care (SOC)] dramatically increases treatment response in selected patients with hepatitis C virus (HCV). Interleukin 28B (IL28Β) genotyping helps predict responsiveness in these patients; however, the economic implications of IL28Β genotyping in HCV genotype 2 or 3 infected patients are unknown. Short- and long-term costs and outcomes of SOC therapy were calculated and used to determine the cost-effectiveness thresholds for using triple therapy in HCV genotype 2 or 3 infected patients. Methods: Costs and outcomes were calculated by conducting cohort simulations on decision trees modeling SOC and triple therapy. Quality-adjusted life expectancies and long-term costs were predicted through Markov modeling. Results: For triple therapy to be cost-effective, sustained virologic response (SVR) rates must improve (depending on age) by 7.91-11.11 and 9.06-12.8% for HCV genotype 2 and 3 cohorts, respectively. When triple therapy is guided by 2 IL28Β variants, a 2.63-3.72% improvement in SVR is needed for cost-effectiveness, and when guided by only one variant, a 1.4-8.91% improvement is needed. Conclusions: Markov modeling revealed that modest increases in SVR rates from IL28Β-guided triple therapy can lead to both lower costs and better health outcomes than SOC therapy in the long run.背景与目的：将蛋白酶抑制剂加入标准治疗（Standard of Care, SOC）的三联疗法，可显著提升特定丙型肝炎病毒（Hepatitis C Virus, HCV）感染患者的治疗应答率。白细胞介素28B（Interleukin 28B, IL28Β）基因分型有助于预测此类患者的治疗应答效果，但针对HCV基因2型或3型感染患者开展IL28Β基因分型的经济学意义尚不明确。本研究通过计算标准治疗的短期与长期成本及结局，明确了针对HCV基因2型或3型感染患者使用三联疗法的成本效益阈值。 研究方法：通过构建模拟标准治疗与三联疗法的决策树开展队列模拟，计算成本与结局；通过马尔可夫（Markov）模型预测质量调整预期寿命与长期成本。 研究结果：若要使三联疗法具备成本效益，HCV基因2型与3型队列的持续病毒学应答（Sustained Virologic Response, SVR）率需分别按年龄区间提升7.91%~11.11%与9.06%~12.8%。当以2种IL28Β变异体指导三联疗法时，需使SVR率提升2.63%~3.72%方可满足成本效益要求；若仅以1种IL28Β变异体指导治疗，则需提升1.4%~8.91%的SVR率。 研究结论：马尔可夫模型分析显示，从长期来看，经IL28Β指导的三联疗法若能适度提升SVR率，相比标准治疗可同时降低医疗成本并改善健康结局。