IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Université Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France.
IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
J Hepatol. 2018 Oct;69(4):785-792. doi: 10.1016/j.jhep.2018.05.027. Epub 2018 Jul 1.
BACKGROUND & AIMS: In Europe, hepatitis C virus (HCV) screening still targets people at high risk of infection. We aim to determine the cost-effectiveness of expanded HCV screening in France.
A Markov model simulated chronic hepatitis C (CHC) prevalence, incidence of events, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER) in the French general population, aged 18 to 80 years, undiagnosed for CHC for different strategies: S1 = current strategy targeting the at risk population; S2 = S1 and all men between 18 and 59 years; S3 = S1 and all individuals between 40 and 59 years; S4 = S1 and all individuals between 40 and 80 years; S5 = all individuals between 18 and 80 years (universal screening). Once CHC was diagnosed, treatment was initiated either to patients with fibrosis stage ≥F2 or regardless of fibrosis. Data were extracted from published literature, a national prevalence survey, and a previously published mathematical model. ICER were interpreted based on one or three times French GDP per capita (€32,800).
Universal screening led to the lowest prevalence of CHC and incidence of events, regardless of treatment initiation. When considering treatment initiation to patients with fibrosis ≥F2, targeting all people aged 40-80 was the only cost-effective strategy at both thresholds (€26,100/QALY). When we considered treatment for all, although universal screening of all individuals aged 18-80 is associated with the highest costs, it is more effective than targeting all people aged 40-80, and cost-effective at both thresholds (€31,100/QALY).
In France, universal screening is the most effective screening strategy for HCV. Universal screening is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of HCV eradication, this strategy should be implemented.
In the context of highly effective and well tolerated therapies for hepatitis C virus that are now recommended for all patients, a reassessment of hepatitis C screening strategies is needed. An effectiveness and cost-effectiveness study of different strategies targeting either the at-risk population, specific ages or all individuals was performed. In France, universal screening is the most effective strategy and is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of hepatitis C virus eradication, this strategy should be implemented.
在欧洲，丙型肝炎病毒（HCV）的筛查仍然针对感染风险高的人群。我们旨在确定在法国扩大 HCV 筛查的成本效益。
采用马尔可夫模型模拟慢性丙型肝炎（CHC）的流行率、事件发生率、质量调整生命年（QALY）、成本和增量成本效益比（ICER），研究对象为未确诊 CHC 的法国普通人群，年龄 18 至 80 岁，针对不同策略：S1=针对高危人群的现行策略；S2=S1 和所有 18 至 59 岁的男性；S3=S1 和所有 40 至 59 岁的个体；S4=S1 和所有 40 至 80 岁的个体；S5=所有 18 至 80 岁的个体（普遍筛查）。一旦诊断出 CHC，无论是否有纤维化，都对纤维化程度≥F2 的患者或所有患者进行治疗。数据取自已发表的文献、一项全国流行情况调查和以前发表的数学模型。根据法国人均国内生产总值（32800 欧元）的一次或三次，对 ICER 进行解释。
无论治疗起始情况如何，普遍筛查都能降低 CHC 的患病率和事件发生率。当考虑对纤维化程度≥F2 的患者进行治疗时，仅针对所有 40-80 岁的人群是在两个阈值（每 QALY 26100 欧元）下唯一具有成本效益的策略。当我们考虑对所有人进行治疗时，虽然对所有 18-80 岁的个体进行普遍筛查会导致最高的成本，但它比针对所有 40-80 岁的个体更有效，并且在两个阈值下都具有成本效益（每 QALY 31100 欧元）。
在法国，普遍筛查是 HCV 最有效的筛查策略。无论纤维化阶段如何，只要开始治疗，普遍筛查就具有成本效益。从 HCV 消除的个体和特别是从社会角度来看，应实施这种策略。
在目前推荐对所有患者使用的高效且耐受良好的丙型肝炎病毒治疗方法的背景下，需要重新评估丙型肝炎病毒的筛查策略。对针对高危人群、特定年龄或所有个体的不同策略进行了有效性和成本效益研究。在法国，普遍筛查是最有效的策略，无论纤维化阶段如何，只要开始治疗，就具有成本效益。从 HCV 消除的个体和特别是从社会角度来看，应实施这种策略。
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