在台湾，基于社区的丙型肝炎病毒核心抗原筛查活动感染具有成本效益。
Hepatitis C virus core antigen is cost-effective in community-based screening of active hepatitis C infection in Taiwan.
机构信息
Division of Hepatogastroenterology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County and National Taiwan University College of Medicine, Taipei City, Taiwan.
出版信息
J Formos Med Assoc. 2020 Jan;119(1 Pt 3):504-508. doi: 10.1016/j.jfma.2019.07.011. Epub 2019 Jul 23.
BACKGROUND AND PURPOSE
Hepatitis C virus (HCV) core antigen is highly sensitive and specific in viremic HCV diagnosis. This study evaluated the cost-effectiveness of HCV core antigen (HCVcAg) in community-based screening for active HCV infection.
METHODS
Between 2017/07 and 2018/07, community-based screenings for active HCV infection with two-step (anti-HCV for screening and HCVRNA for diagnosis) and one-step processes (HCVcAg for screening and diagnosis) were conducted in two districts in Kaohsiung City. While HCVcAg test was positive at ≥3 fmol/L, the lowest level of HCV-RNA detection was 12 IU/mL. We analyzed the cost-effectiveness of two algorithms in identifying active HCV infection.
RESULTS
There were two large-scale screenings using the two-step process with a total of 2452 residents enrolled; while six hundred and forty-four residents participated in continuous small-scale screening with the one-step process. The prevalence of anti-HCV and positive HCVcAg was 3.4% and 2.8%. The viremic rate was 1.4% and 2.8% for two- and one-step processes (p < 0.001). While all positive HCVcAg were viremic, 42.4% of positive anti-HCV patients had viremia. The positive predictive value was 42.2% and 100% for two- and one-step processes in detecting active HCV infection (p < 0.001). In identifying one active HCV infection, the cost was $755.3 and $711.1 dollars for two- and one-step processes respectively.
CONCLUSION
Compared to the two-step process in community-based screening, continuous screening with the HCVcAg test as a one-step tool for active HCV infection was cost-effective in areas with low seroprevalence of HCV in Taiwan.
背景与目的
丙型肝炎病毒（HCV）核心抗原在病毒血症 HCV 诊断中具有高度的敏感性和特异性。本研究评估了 HCV 核心抗原（HCVcAg）在社区为基础的主动 HCV 感染筛查中的成本效益。
方法
2017 年 7 月至 2018 年 7 月期间，在高雄市的两个区进行了基于社区的主动 HCV 感染两步法（抗 HCV 用于筛查，HCVRNA 用于诊断）和一步法（HCVcAg 用于筛查和诊断）筛查。当 HCVcAg 检测值≥3 fmol/L 时，最低 HCV-RNA 检测水平为 12 IU/mL。我们分析了两种算法在识别活跃性 HCV 感染方面的成本效益。
结果
共进行了两次大型的两步法筛查，共有 2452 名居民参与；而 644 名居民参加了连续的小规模筛查，采用一步法。抗 HCV 和阳性 HCVcAg 的患病率分别为 3.4%和 2.8%。两步法和一步法的病毒血症率分别为 1.4%和 2.8%（p<0.001）。虽然所有阳性的 HCVcAg 均为病毒血症，但阳性抗 HCV 患者中有 42.4%的人有病毒血症。两步法和一步法在检测活跃性 HCV 感染方面的阳性预测值分别为 42.2%和 100%（p<0.001）。在识别一个活跃性 HCV 感染的情况下，两步法和一步法的成本分别为 755.3 美元和 711.1 美元。
结论
与社区为基础的两步法筛查相比，在台湾 HCV 血清流行率较低的地区，使用 HCVcAg 检测作为一种一步工具进行连续筛查对于主动 HCV 感染具有成本效益。
Zotero 插件