Gubay F, Staunton R, Metzig C, Abubakar I, White P J
MRC Centre for Outbreak Analysis and Modelling and NIHR Health Protection Research Unit in Modelling Methodology, School of Public Health, Imperial College London, London, UK.
Department of Mathematics, Imperial College London, London, UK.
J Viral Hepat. 2018 May;25(5):514-523. doi: 10.1111/jvh.12847. Epub 2018 Mar 1.
Hepatitis C virus (HCV) is a major and growing public health concern. We need to know the expected health burden and treatment cost, and understand uncertainty in those estimates, to inform policymaking and future research. Two models that have been important in informing treatment guidelines and assessments of HCV burden were compared by simulating cohorts of individuals with chronic HCV infection initially aged 20, 35 and 50 years. One model predicts that health losses (measured in quality-adjusted life-years [QALYs]) and treatment costs decrease with increasing initial age of the patients, whilst the other model predicts that below 40 years, costs increase and QALY losses change little with age, and above 40 years, they decline with increasing age. Average per-patient costs differ between the models by up to 38%, depending on the patients' initial age. One model predicts double the total number, and triple the peak annual incidence, of liver transplants compared to the other model. One model predicts 55%-314% more deaths than the other, depending on the patients' initial age. The main sources of difference between the models are estimated progression rates between disease states and rates of health service utilization associated with different disease states and, in particular, the age dependency of these parameters. We conclude that decision-makers need to be aware that uncertainties in the health burden and economic cost of HCV disease have important consequences for predictions of future need for care and cost-effectiveness of interventions to avert HCV transmission, and further quantification is required to inform decisions.
丙型肝炎病毒（HCV）是一个日益严重的重大公共卫生问题。我们需要了解预期的健康负担和治疗成本，并认识到这些估计中的不确定性，以便为政策制定和未来研究提供信息。通过模拟初始年龄为20岁、35岁和50岁的慢性HCV感染个体队列，对在为HCV负担的治疗指南和评估提供信息方面具有重要作用的两种模型进行了比较。一种模型预测，健康损失（以质量调整生命年[QALYs]衡量）和治疗成本会随着患者初始年龄的增加而降低，而另一种模型预测，在40岁以下，成本会增加，QALY损失随年龄变化不大，在40岁以上，它们会随着年龄的增加而下降。根据患者的初始年龄，各模型之间的人均成本差异高达38%。与另一种模型相比，一种模型预测的肝移植总数是其两倍，年度发病率峰值是其三倍。根据患者的初始年龄，一种模型预测的死亡人数比另一种模型多55%-314%。各模型之间差异的主要来源是疾病状态之间的估计进展率以及与不同疾病状态相关的卫生服务利用率，特别是这些参数的年龄依赖性。我们得出结论，决策者需要意识到，HCV疾病的健康负担和经济成本的不确定性对未来护理需求的预测以及避免HCV传播干预措施的成本效益具有重要影响，需要进一步量化以提供决策依据。
