Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Find & Treat, NHS, London, UK.
J Antimicrob Chemother. 2019 Nov 1;74(Suppl 5):v5-v16. doi: 10.1093/jac/dkz451.
HCV disproportionately affects marginalized communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilizing HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care.
To assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared with standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care).
Cost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact. The model was parameterized using London-specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 197 were identified as HCV RNA positive, 180 attended secondary care and 89 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50 year time horizon.
For a willingness-to-pay threshold of £20000 per QALY gained, the HepFriend initiative is cost-effective, with a mean ICER of £9408/QALY, and would become cost saving at 27% (£10525 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions, and if treatment rates are doubled the intervention becomes more cost-effective (£8853/QALY).
New models of care that undertake active case-finding with enhanced peer support to improve testing and treatment uptake amongst marginalized and vulnerable groups could be highly cost-effective and possibly cost saving.
丙型肝炎（HCV）在无家可归者和注射毒品者（PWID）等弱势群体中发病率较高，对传统医疗服务构成挑战。伦敦的 HepFriend 计划是一种利用 HCV 外展筛查和同伴支持来将弱势群体与二级保健中的 HCV 治疗联系起来的护理模式。
从医疗服务提供者的角度评估 HepFriend 计划相对于标准护理途径（包括初级保健和其他静态场所的检测，包括药物治疗中心，以及与二级保健的联系）的成本效益。
使用 HCV 在 PWID 和已停止注射毒品者中的传播和疾病进展的动态模型进行成本效益分析，包括住房状况和药物治疗服务接触情况。该模型使用伦敦特有的监测和调查数据以及初级干预成本和有效性数据（2015 年 9 月至 2018 年 6 月）进行参数化。在 461 名接受筛查的个体中，有 197 名被确定为 HCV RNA 阳性，180 名接受了二级保健，到目前为止已有 89 名开始接受治疗。使用 50 年时间范围确定增量成本效益比（ICER）。
对于每增加一个质量调整生命年（QALY）愿意支付 20000 英镑的意愿支付阈值，HepFriend 计划具有成本效益，平均 ICER 为 9408 英镑/QALY，并且在当前药物价格的 27%（每治疗费用 10525 英镑）时将具有成本效益。结果对干预成本和模型假设的变化具有稳健性，如果治疗率提高一倍，干预措施将更具成本效益（每 QALY 为 8853 英镑）。
对于边缘化和弱势人群，采用主动病例发现并加强同伴支持以提高检测和治疗参与度的新护理模式可能具有很高的成本效益，甚至可能具有成本效益。
