Mendlowitz Andrew B, Naimark David, Wong William W L, Capraru Camelia, Feld Jordan J, Isaranuwatchai Wanrudee, Krahn Murray
Toronto Health Economics and Technology Assessment Collaborative, Toronto, ON, Canada.
Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Liver Int. 2020 Jun;40(6):1282-1291. doi: 10.1111/liv.14458. Epub 2020 Apr 30.
The World Health Organization's hepatitis C virus (HCV) elimination strategy recognizes the need for interventions that identify populations most affected by infection. The emergency department (ED) has been suggested as a setting for HCV screening. The study objective was to explore the health and economic impact of HCV screening in the ED setting.
We used a microsimulation model to conduct a cost-utility analysis evaluating two ED setting-specific strategies: no screening, and screening and subsequent treatment. Strategies were examined for two populations: (a) the general ED patient population; and (b) ED patients born between 1945 and 1975. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon. A reference and high ED HCV seroprevalence measure were examined in the Canadian healthcare setting.US costs of chronic infection were used for a scenario analysis of screening in the US healthcare setting.
For birth cohort screening, in comparison to no screening, one liver-related death was averted for every 760 and 123 persons screened for the reference and high seroprevalence measures. For general population screening, one liver-related death was averted for every 831 and 147 persons screened for the reference and high seroprevalence measures. In comparison to no screening, birth cohort screening was cost-effective at CAN$25,584/quality-adjusted life year (QALY) and US$42,615/QALY. General population screening was cost-effective at CAN$19,733/QALY and US$32,187/QALY.
ED screening may represent a cost-effective component of population-based strategies to eliminate HCV. Further studies are warranted to explore the feasibility and acceptability of this approach.
世界卫生组织的丙型肝炎病毒（HCV）消除战略认识到需要采取干预措施来识别受感染影响最严重的人群。急诊科（ED）已被提议作为HCV筛查的场所。本研究的目的是探讨在急诊科环境中进行HCV筛查对健康和经济的影响。
我们使用微观模拟模型进行成本效用分析，评估两种针对急诊科环境的特定策略：不进行筛查，以及进行筛查并随后进行治疗。针对两个人群对策略进行了研究：（a）急诊科普通患者人群；（b）1945年至1975年出生的急诊科患者。分析是从医疗保健支付者的角度在终身时间范围内进行的。在加拿大医疗保健环境中研究了参考和高急诊科HCV血清流行率测量值。美国慢性感染成本用于美国医疗保健环境中筛查的情景分析。
对于出生队列筛查，与不进行筛查相比，对于参考和高血清流行率测量值，每筛查760人和123人可避免1例与肝脏相关的死亡。对于普通人群筛查，对于参考和高血清流行率测量值，每筛查831人和147人可避免1例与肝脏相关的死亡。与不进行筛查相比，出生队列筛查的成本效益为每质量调整生命年（QALY）25,584加元和42,615美元。普通人群筛查的成本效益为每QALY 19,733加元和32,187美元。
急诊科筛查可能是基于人群的HCV消除策略中具有成本效益的组成部分。有必要进一步研究以探讨这种方法的可行性和可接受性。
