Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States.
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, United States.
Drug Alcohol Depend. 2018 Apr 1;185:411-420. doi: 10.1016/j.drugalcdep.2017.11.031. Epub 2018 Feb 21.
We evaluated the cost-effectiveness of a hepatitis C (HCV) screening and active linkage to care intervention in US methadone maintenance treatment (MMT) patients using data from a randomized trial conducted in New York City and San Francisco.
We used a decision analytic model to compare 1) no intervention; 2) HCV screening and education (control); and 3) HCV screening, education, and care coordination (active linkage intervention). We also explored an alternative strategy wherein HCV/HIV co-infected participants linked elsewhere. Trial data include population characteristics (67% male, mean age 48, 58% HCV infected) and linkage rates. Data from published sources include treatment efficacy and HCV re-infection risk. We projected quality-adjusted life years (QALYs) and lifetime medical costs using an established model of HCV (HEP-CE). Incremental cost-effectiveness ratios (ICERs) are in 2015 US$/QALY discounted 3% annually.
The control strategy resulted in a projected 35% linking to care within 6 months and 31% achieving sustained virologic response (SVR). The intervention resulted in 60% linking and 54% achieving SVR with an ICER of $24,600/QALY compared to no intervention from the healthcare sector perspective and was a more efficient use of resources than the control strategy. The intervention had an ICER of $76,500/QALY compared to the alternative strategy. From a societal perspective, the intervention had a net monetary benefit of $511,000-$975,600.
HCV care coordination interventions that include screening, education and active linkage to care in MMT settings are likely cost-effective at a conventional $100,000/QALY threshold for both HCV mono-infected and HIV co-infected patients.
我们利用在纽约市和旧金山进行的一项随机试验的数据，评估了对美国美沙酮维持治疗（MMT）患者进行 HCV（丙型肝炎）筛查和积极转介护理干预的成本效益。
我们使用决策分析模型来比较 1）无干预；2）HCV 筛查和教育（对照）；3）HCV 筛查、教育和护理协调（积极转介干预）。我们还探索了一种替代策略，即 HCV/HIV 合并感染的参与者在其他地方转介。试验数据包括人口特征（67%为男性，平均年龄 48 岁，58%为 HCV 感染）和转介率。来自已发表来源的数据包括治疗效果和 HCV 再感染风险。我们使用 HCV（HEP-CE）的既定模型来预测质量调整生命年（QALYs）和终生医疗费用。增量成本效益比（ICER）以 2015 年的 3%贴现，每年贴现 3%。
对照策略预计将有 35%的患者在 6 个月内转介至护理，31%的患者实现持续病毒学应答（SVR）。干预策略使 60%的患者转介并使 54%的患者达到 SVR，其增量成本效益比（ICER）为 24600 美元/QALY，与从医疗保健部门的角度来看，与无干预相比，该策略更有效利用了资源。与替代策略相比，干预策略的 ICER 为 76500 美元/QALY。从社会角度来看，干预措施的净货币收益为 511000 美元至 975600 美元。
在 HCV 单感染和 HIV 合并感染患者的 10 万美元/QALY 常规阈值下，包括 MMT 环境中的筛查、教育和积极转介护理的 HCV 护理协调干预措施可能具有成本效益。
