Stein Ken, Dalziel Kim, Walker Andrew, Jenkins Becky, Round Alison, Royle Pam
Peninsula Technology Assessment Group, Peninsula Medical School, Universities of Exeter and Plymouth, Dean Clarke House, Southernhay East, Exeter EX1 1PQ.
J Public Health (Oxf). 2004 Mar;26(1):61-71. doi: 10.1093/pubmed/fdh109.
Hepatitis C is a major public health problem of increasing importance among injecting drug users, among whom screening has been proposed. We therefore estimated the cost utility of screening for hepatitis C infection among people with a history of injecting drug use in contact with drug misuse services.
A spreadsheet-based model of screening using ELISA followed by polymerase chain reaction tests and treatment using combination therapy with interferon alpha and ribavirin was developed. Parameters were informed by literature review, expert opinion and a survey of current screening practice in England. A range of one-way sensitivity analyses were carried out to explore uncertainty in the results for cost effectiveness.
Screening for HCV is likely to yield benefits in the population concerned at around 28,000 pounds per quality adjusted life year. This estimate is reasonably stable when explored in extensive one-way sensitivity analysis but appeared sensitive to the proportion of HCV positive people who accept biopsy or treatment and the utility gains associated with successful drug treatment. Important other areas of uncertainty include the effects of mortality from other causes on the cost effectiveness of screening in this population and the time at which symptoms would have led to presentation in the absence of a screening programme.
Screening for HCV in this population is moderately cost effective, although some caution must remain in accepting this estimate given the current uncertainties in this field, and further research is required.
丙型肝炎是一个日益重要的主要公共卫生问题，在注射吸毒者中尤为突出，有人提议对这一群体进行筛查。因此，我们估计了在与药物滥用服务机构有接触的有注射吸毒史人群中筛查丙型肝炎感染的成本效益。
建立了一个基于电子表格的筛查模型，先采用酶联免疫吸附测定（ELISA），随后进行聚合酶链反应检测，并采用α干扰素和利巴韦林联合治疗。通过文献综述、专家意见以及对英国当前筛查实践的调查确定参数。进行了一系列单向敏感性分析，以探讨成本效益结果的不确定性。
在相关人群中筛查丙型肝炎病毒（HCV）可能会带来效益，每获得一个质量调整生命年的成本约为28,000英镑。在广泛的单向敏感性分析中，这一估计相当稳定，但似乎对接受活检或治疗的HCV阳性人群比例以及与成功药物治疗相关的效用增益敏感。其他重要的不确定领域包括其他原因导致的死亡率对该人群筛查成本效益的影响，以及在没有筛查计划的情况下症状导致就诊的时间。
在这一人群中筛查HCV具有一定的成本效益，不过鉴于该领域目前存在的不确定性，在接受这一估计时仍需谨慎，还需要进一步研究。
