Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, CA.
Am J Transplant. 2013 Oct;13(10):2611-8. doi: 10.1111/ajt.12429. Epub 2013 Aug 22.
For solid organ transplant (SOT) donors, nucleic acid-amplification testing (NAT) may reduce human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission over antibody (Ab) testing given its shorter detection window period. We compared SOT donor NAT + Ab versus Ab alone using decision models to estimate incremental cost-effectiveness ratios (ICERs; cost per quality-adjusted life year [QALY] gained) from the societal perspective across a range of HIV/HCV prevalence values and NAT costs. The cost per QALY gained was calculated for two scenarios: (1) favorable: low cost ($150/donor)/high prevalence (HIV: 1.5%; HCV: 18.2%) and (2) unfavorable: high cost ($500/donor)/low prevalence (HIV: 0.1%; HCV: 1.5%). In the favorable scenario, adding NAT screening cost $161 013 per QALY gained for HIV was less costly) for HCV, and cost $86 653 per QALY gained for HIV/HCV combined. For the unfavorable scenario, the costs were $15 568 484, $221 006 and $10 077 599 per QALY gained, respectively. Universal HCV NAT + Ab for donors appears cost-effective to reduce infection transmission from SOT donors, while HIV NAT + Ab is not, except where HIV NAT is ≤$150/donor and prevalence is ≥1.5%. Our analyses provide important data to facilitate the decision to implement HIV and HCV NAT for deceased SOT donors and shape national policy regarding how to reduce infection transmission in SOT.
对于实体器官移植（SOT）供体，核酸扩增检测（NAT）可能会减少人类免疫缺陷病毒（HIV）和丙型肝炎病毒（HCV）的传播，因为其检测窗口期更短。我们使用决策模型比较了 SOT 供体的 NAT+Ab 与单独的 Ab，以从社会角度估算在一系列 HIV/HCV 流行率值和 NAT 成本范围内的增量成本效益比（ICER；每获得质量调整生命年的成本[QALY]）。在两种情况下计算了每获得 QALY 的成本：（1）有利情况：低成本（$150/供体）/高流行率（HIV：1.5%；HCV：18.2%）和（2）不利情况：高成本（$500/供体）/低流行率（HIV：0.1%；HCV：1.5%）。在有利的情况下，增加 NAT 筛查成本为每 QALY 获得$161013 对 HIV 来说更便宜），对 HCV 来说，每 QALY 获得$221006，对 HIV/HCV 联合来说，每 QALY 获得$10077599。在不利的情况下，成本分别为每 QALY 获得$15568484、$221006 和$10077599。对于 SOT 供体，普遍采用 HCV NAT+Ab 进行检测，似乎可以降低感染传播的成本效益，而 HIV NAT+Ab 则不然，除非 HIV NAT 低于$150/供体且流行率高于 1.5%。我们的分析提供了重要数据，以促进对实施 HIV 和 HCV NAT 进行决策，为减少 SOT 中的感染传播制定国家政策。
