对男男性行为人群中 HIV 感染者进行急性丙型肝炎病毒感染的成本效益筛查。
Cost-effective screening for acute hepatitis C virus infection in HIV-infected men who have sex with men.
机构信息
HIV Epidemiology and Outcomes Research Unit, Section of Infectious Diseases, Boston Medical Center, Boston, MA 02118, USA.
出版信息
Clin Infect Dis. 2012 Jul;55(2):279-90. doi: 10.1093/cid/cis382. Epub 2012 Apr 4.
BACKGROUND
We used a Monte Carlo computer simulation to estimate the effectiveness and cost-effectiveness of screening for acute hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected men who have sex with men.
METHODS
One-time screening for prevalent HCV infection was performed at the time of enrollment in care, followed by either symptom-based screening, screening with liver function tests (LFTs), HCV antibody (Ab) screening, or HCV RNA screening in various combinations and intervals. We considered both treatment with pegylated interferon and ribavirin (PEG/RBV) alone and with an HCV protease inhibitor. Outcome measures were life expectancy, quality-adjusted life expectancy, direct medical costs, and cost-effectiveness, assuming a societal willingness to pay $100000 per quality-adjusted life-year (QALY) gained.
RESULTS
All strategies increased life expectancy (from 0.49 to 0.94 life-months), quality-adjusted life expectancy (from 0.47 to 1.00 quality-adjusted life-months), and costs (from $1900 to $7600), compared with symptom-based screening. The incremental cost-effectiveness ratio of screening with 6-month LFTs and a 12-month HCV Ab test, compared with symptom-based screening, was $43 700/QALY (for PEG/RBV alone) and $57 800/QALY (for PEG/RBV plus HCV protease inhibitor). The incremental cost-effectiveness ratio of screening with 3-month LFTs, compared with 6-month LFTs plus a 12-month HCV Ab test, was $129 700/QALY (for PEG/RBV alone) and $229 900/QALY (for PEG/RBV plus HCV protease inhibitor). With HCV protease inhibitor-based therapy, screening with 6-month LFTs and a 12-month HCV Ab test was the optimal strategy when the HCV infection incidence was ≤1.25 cases/100 person-years. The 3-month LFT strategy was optimal when the incidence was >1.25 cases/100 person-years.
CONCLUSIONS
Screening for acute HCV infection in HIV-infected MSM prolongs life expectancy and is cost-effective. Depending on incidence, regular screening with LFTs, with or without an HCV Ab test, is the optimal strategy.
背景
我们使用蒙特卡罗计算机模拟来估计对人类免疫缺陷病毒（HIV）感染的男男性行为者中急性丙型肝炎病毒（HCV）感染进行筛查的效果和成本效益。
方法
在接受护理时进行一次 HCV 现患感染筛查，然后根据症状进行筛查、肝功能检查（LFT）筛查、HCV 抗体（Ab）筛查或 HCV RNA 筛查，采用不同的组合和间隔。我们同时考虑了单独使用聚乙二醇干扰素和利巴韦林（PEG/RBV）以及联合 HCV 蛋白酶抑制剂的治疗。结果指标为预期寿命、质量调整预期寿命、直接医疗费用和成本效益，假设社会愿意为每增加一个质量调整生命年（QALY）支付 100000 美元。
结果
与基于症状的筛查相比，所有策略都增加了预期寿命（从 0.49 生命月增加到 0.94 生命月）、质量调整预期寿命（从 0.47 质量调整生命月增加到 1.00 质量调整生命月）和成本（从 1900 美元增加到 7600 美元）。与基于症状的筛查相比，每 6 个月进行一次 LFT 和每 12 个月进行一次 HCV Ab 检测的筛查策略的增量成本效益比为 43700 美元/QALY（仅使用 PEG/RBV）和 57800 美元/QALY（使用 PEG/RBV 加 HCV 蛋白酶抑制剂）。与每 6 个月进行一次 LFT 加每 12 个月进行一次 HCV Ab 检测的筛查相比，每 3 个月进行一次 LFT 的筛查策略的增量成本效益比为 129700 美元/QALY（仅使用 PEG/RBV）和 229900 美元/QALY（使用 PEG/RBV 加 HCV 蛋白酶抑制剂）。当 HCV 感染发生率≤1.25 例/100 人年时，基于 HCV 蛋白酶抑制剂的治疗，每 6 个月进行一次 LFT 和每 12 个月进行一次 HCV Ab 检测的筛查策略是最佳策略。当感染发生率>1.25 例/100 人年时，3 个月的 LFT 策略是最佳策略。
结论
对 HIV 感染的男男性行为者中急性 HCV 感染进行筛查可延长预期寿命，且具有成本效益。根据感染发生率，定期进行 LFT 检查，无论是否进行 HCV Ab 检查，都是最佳策略。
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