将预防、检测和治疗措施升级，以控制达累斯萨拉姆市（坦桑尼亚）的丙型肝炎，作为公共卫生威胁：成本效益模型。
Upscaling prevention, testing and treatment to control hepatitis C as a public health threat in Dar es Salaam, Tanzania: A cost-effectiveness model.
机构信息
Burnet Institute, 85 Commercial Rd, Melbourne, Victoria 3004, Australia; Monash University, Clayton, Australia.
Imperial College London, St Mary's Hospital, London, UK.
出版信息
Int J Drug Policy. 2021 Feb;88:102634. doi: 10.1016/j.drugpo.2019.102634. Epub 2019 Dec 24.
BACKGROUND
Hepatitis C (HCV) elimination strategies are required for low and middle-income countries (LMICs), because although treatment access is currently limited, this is unlikely to remain the case forever. We estimate and compare the impact, cost and cost-effectiveness of a variety of prevent, test and treat strategies for HCV in Dar es Salaam, Tanzania.
METHODS
A mathematical model.
RESULTS
Without intervention, the HCV epidemic in Dar es Salaam was estimated to result in US$29.1 million in disease costs between 2018 and 2030. Maintaining existing harm reduction coverage (4% needle and syringe program, 42% opioid substitution therapy) over this period was estimated to prevent 22% of injecting drug use-acquired HCV infections compared to a zero coverage scenario. Implementing antibody/RNA, serum-based HCV core antigen (HCVcAg) and dry blood spot (DBS) HCVcAg test/treat programs among PWID increased the total cost by US$0.7 million, US$3.1 million and US$6.5 million respectively by 2030; however this expenditure led to 57%, 61% and 73% reductions in annual incidence among PWID, 25%, 27% and 33% reductions overall annual incidence (PWID+non-PWID), and reduced HCV prevalence among PWID from 27% to 9%, 8% and 5%, respectively. The Ab/RNA, serum-based and DBS HCVcAg test/treat programs cost US$689, US$2857 and US$5400 per disability-adjusted life year averted, respectively, compared to no test/treat program.
CONCLUSION
Primary prevention among PWID can provide important reductions in HCV transmission in the absence of treatment availability. HCV Ab/RNA or serum-based HCVcAg test/treat programs among PWID are likely to be cost-effective in Dar es Salaam, with serum-based HCVcAg test/treat achieving greater impact due to a simpler diagnostic process and better retention in care. If used for regular testing of PWID, the additional coverage benefits of non-laboratory-based DBS HCVcAg tests in LMICs would outweigh their reduced sensitivity.
背景
中低收入国家（LMICs）需要实施丙型肝炎（HCV）消除策略，因为尽管目前治疗机会有限，但这种情况不太可能永远持续下去。我们估计并比较了坦桑尼亚达累斯萨拉姆地区各种预防、检测和治疗 HCV 的策略的影响、成本和成本效益。
方法
数学模型。
结果
如果不采取干预措施，据估计，2018 年至 2030 年期间，达累斯萨拉姆的 HCV 流行将导致 2910 万美元的疾病成本。与零覆盖情景相比，在这一期间维持现有的减少伤害覆盖范围（4%的针具交换计划，42%的阿片类药物替代疗法），预计可预防 22%的注射吸毒者获得 HCV 感染。在注射吸毒者中实施抗体/RNA、基于血清的 HCV 核心抗原（HCVcAg）和干血斑（DBS）HCVcAg 检测/治疗方案，到 2030 年将分别使总成本增加 700 万美元、3100 万美元和 6500 万美元；然而，这一支出使注射吸毒者的年发病率分别减少了 57%、61%和 73%，总体年发病率（注射吸毒者+非注射吸毒者）减少了 25%、27%和 33%，使注射吸毒者的 HCV 流行率从 27%降至 9%、8%和 5%。与无检测/治疗方案相比，Ab/RNA、基于血清的和 DBS HCVcAg 检测/治疗方案分别使每例残疾调整生命年的成本效益为 689 美元、2857 美元和 5400 美元。
结论
在没有治疗方法的情况下，对注射吸毒者进行初级预防可以显著减少 HCV 传播。在达累斯萨拉姆，对注射吸毒者进行 HCV Ab/RNA 或基于血清的 HCVcAg 检测/治疗方案可能具有成本效益，基于血清的 HCVcAg 检测/治疗方案由于诊断过程更简单且更有利于接受治疗，因此具有更大的影响。如果用于定期检测注射吸毒者，在中低收入国家，非实验室基于 DBS HCVcAg 检测的额外覆盖效益将超过其敏感性降低的影响。
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