NORC at the University of Chicago, Illinois, USA.
Ann Intern Med. 2012 Feb 21;156(4):263-70. doi: 10.7326/0003-4819-156-4-201202210-00378. Epub 2011 Nov 4.
In the United States, hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and approximately 50% to 75% of infected adults are unaware of their infection.
To estimate the cost-effectiveness of birth-cohort screening.
Cost-effectiveness simulation.
National Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, and published sources.
Adults born from 1945 through 1965 with 1 or more visits to a primary care provider annually.
Lifetime.
Societal, health care.
One-time antibody test of 1945-1965 birth cohort.
Numbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted life-years (QALYs); incremental cost-effectiveness ratio (ICER).
RESULTS OF BASE-CASE ANALYSIS: Compared with the status quo, birth-cohort screening identified 808,580 additional cases of chronic HCV infection at a screening cost of $2874 per case identified. Assuming that birth-cohort screening was followed by pegylated interferon and ribavirin (PEG-IFN+R) for treated patients, screening increased QALYs by 348,800 and costs by $5.5 billion, for an ICER of $15,700 per QALY gained. Assuming that birth-cohort screening was followed by direct-acting antiviral plus PEG-IFN+R treatment for treated patients, screening increased QALYs by 532,200 and costs by $19.0 billion, for an ICER of $35,700 per QALY saved.
The ICER of birth-cohort screening was most sensitive to sustained viral response of antiviral therapy, the cost of therapy, the discount rate, and the QALY losses assigned to disease states.
Empirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce.
Birth-cohort screening for HCV in primary care settings was cost-effective.
Division of Viral Hepatitis, Centers for Disease Control and Prevention.
在美国，丙型肝炎病毒（HCV）感染在 1945 年至 1965 年期间出生的成年人中最为普遍，约有 50%至 75%的感染者不知道自己的感染情况。
评估出生队列筛查的成本效益。
成本效益模拟。
国家健康和营养调查、美国人口普查、医疗保险报销时间表和已发表的资料。
每年至少有 1 次就诊于初级保健提供者的 1945 年至 1965 年期间出生的成年人。
终身。
社会层面，医疗保健。
对 1945 年至 1965 年出生队列进行一次性抗体检测。
发现和治疗的病例数以及实现持续病毒应答的病例数；丙型肝炎相关的肝病和死亡；医疗和生产力成本；质量调整生命年（QALY）；增量成本效益比（ICER）。
与现状相比，出生队列筛查发现了 808580 例额外的慢性 HCV 感染病例，每个病例的筛查成本为 2874 美元。假设出生队列筛查后对治疗患者采用聚乙二醇干扰素和利巴韦林（PEG-IFN+R）治疗，筛查增加了 348800 个 QALY，并增加了 55 亿美元的成本，ICER 为每获得一个 QALY 需花费 15700 美元。假设出生队列筛查后对治疗患者采用直接作用抗病毒药物联合 PEG-IFN+R 治疗，筛查增加了 532200 个 QALY，并增加了 190 亿美元的成本，ICER 为每节省一个 QALY 需花费 35700 美元。
出生队列筛查的 ICER 对抗病毒治疗的持续病毒应答率、治疗成本、贴现率以及疾病状态下的 QALY 损失最为敏感。
真实临床环境中关于筛查和直接作用抗病毒治疗的经验数据稀缺。
在初级保健环境中对 HCV 进行出生队列筛查具有成本效益。
疾病控制与预防中心病毒肝炎科。
