Department of Management Science and Engineering, Stanford University, Stanford, California, USA.
PLoS One. 2012;7(9):e45176. doi: 10.1371/journal.pone.0045176. Epub 2012 Sep 18.
To estimate the cost, effectiveness, and cost effectiveness of HIV and HCV screening of injection drug users (IDUs) in opioid replacement therapy (ORT).
Dynamic compartmental model of HIV and HCV in a population of IDUs and non-IDUs for a representative U.S. urban center with 2.5 million adults (age 15-59).
We considered strategies of screening individuals in ORT for HIV, HCV, or both infections by antibody or antibody and viral RNA testing. We evaluated one-time and repeat screening at intervals from annually to once every 3 months. We calculated the number of HIV and HCV infections, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).
Adding HIV and HCV viral RNA testing to antibody testing averts 14.8-30.3 HIV and 3.7-7.7 HCV infections in a screened population of 26,100 IDUs entering ORT over 20 years, depending on screening frequency. Screening for HIV antibodies every 6 months costs $30,700/QALY gained. Screening for HIV antibodies and viral RNA every 6 months has an ICER of $65,900/QALY gained. Strategies including HCV testing have ICERs exceeding $100,000/QALY gained unless awareness of HCV-infection status results in a substantial reduction in needle-sharing behavior.
Although annual screening for antibodies to HIV and HCV is modestly cost effective compared to no screening, more frequent screening for HIV provides additional benefit at less cost. Screening individuals in ORT every 3-6 months for HIV infection using both antibody and viral RNA technologies and initiating ART for acute HIV infection appears cost effective.
评估在阿片类物质替代疗法（ORT）中对注射吸毒者（IDU）进行 HIV 和 HCV 筛查的成本、效果和成本效益。
针对一个拥有 250 万成年人（15-59 岁）的美国代表性城市中心，对 HIV 和 HCV 在 IDU 和非 IDU 人群中的动态隔室模型进行研究。
我们考虑了通过抗体或抗体和病毒 RNA 检测对 ORT 中的个体进行 HIV、HCV 或两种感染筛查的策略。我们评估了每年一次、每三个月一次等不同间隔的一次性和重复筛查。我们计算了 HIV 和 HCV 感染的数量、质量调整生命年（QALY）、成本和增量成本效益比（ICER）。
在接受 ORT 的 26100 名 IDU 中，每 6 个月对 HIV 抗体进行一次筛查，每年进行一次 HCV 检测，可避免 14.8-30.3 例 HIV 和 3.7-7.7 例 HCV 感染，具体取决于筛查频率。每 6 个月筛查一次 HIV 抗体的成本为 30700 美元/QALY。每 6 个月筛查 HIV 抗体和病毒 RNA 的 ICER 为 65900 美元/QALY。如果 HCV 感染状况的知晓率导致共用针头行为大幅减少，那么包括 HCV 检测在内的策略的 ICER 超过 100000 美元/QALY。
与不筛查相比，每年对 HIV 和 HCV 抗体进行筛查虽然适度有效，但更频繁地筛查 HIV 可以以更低的成本提供更多的收益。对 ORT 中的个体每 3-6 个月使用抗体和病毒 RNA 技术进行 HIV 感染筛查，并对急性 HIV 感染启动 ART，似乎具有成本效益。
