Stein Ken, Dalziel Kim, Walker Andrew, Jenkins Becky, Round Alison, Royle Pam
Peninsula Technology Assessment Group, University of Exeter, Southernhay East, Exeter EX1 1PQ, UK.
J Hepatol. 2003 Nov;39(5):814-25. doi: 10.1016/s0168-8278(03)00392-1.
BACKGROUND/AIMS: To estimate the cost utility (cost per QALY) of screening for hepatitis C (HCV) infection in people attending genito-urinary medicine clinics in England.
An epidemiological model of screening and diagnosis was combined with a Markov chain model of treatment with combination therapy to estimate cost utility. Parameters for the model were informed by literature review, expert opinion and a survey of current screening practice.
The base case estimate was about pound 85,000 per QALY. Selective screening is more cost effective. If screening is restricted to only 20% or 10% of attenders, cost utility is estimated as pound 39,647 and pound 34,288 per QALY. If screening is restricted only to those with a history of injecting drug use, cost utility would be pound 27,138 per QALY. Estimates are particularly sensitive to acceptance rates for screening and treatment.
Universal screening for HCV in GUM clinics is unlikely to be cost effective. There is limited evidence to support screening of people other than those with a history of injecting drug use and even this policy should be considered with some care and in the context of further research.
背景/目的：评估在英国泌尿生殖医学诊所对患者进行丙型肝炎（HCV）感染筛查的成本效用（每质量调整生命年的成本）。
将筛查和诊断的流行病学模型与联合治疗的马尔可夫链模型相结合，以评估成本效用。该模型的参数通过文献综述、专家意见以及对当前筛查实践的调查得出。
基本情况估计约为每质量调整生命年85,000英镑。选择性筛查更具成本效益。如果筛查仅限制在20%或10%的就诊者中，成本效用估计为每质量调整生命年39,647英镑和34,288英镑。如果筛查仅限制在有注射吸毒史的人群中，成本效用将为每质量调整生命年27,138英镑。估计值对筛查和治疗的接受率特别敏感。
在泌尿生殖医学诊所对HCV进行普遍筛查不太可能具有成本效益。几乎没有证据支持对有注射吸毒史以外的人群进行筛查，即使是这一政策也应在进一步研究的背景下谨慎考虑。
