Health Economics and Health Technology Assessment (HEHTA), Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK.
School of Medicine, University of Dundee, Ninewells hospital and Medical school, DD1 9SY Dundee, UK.
Int J Drug Policy. 2020 Aug;82:102811. doi: 10.1016/j.drugpo.2020.102811. Epub 2020 Jun 22.
In developed countries, people who inject drugs (PWID) have a high prevalence of hepatitis C virus (HCV), yet they are often under-diagnosed. The World Health Organization has set 2030 as a target year for HCV elimination. To meet this target, improving screening in convenient community settings in order to reach infected undiagnosed individuals is a priority. This study assesses the cost-effectiveness of alternative novel strategies for diagnosing HCV infection in PWID.
A cost-effectiveness analysis was undertaken to compare HCV screening at needle exchange centres, substance misuse services and at community pharmacies, with the standard practice of detection during general practitioners' consultations. A decision tree model was developed to assess the incremental cost per positive diagnosis, and a Markov model explored the net monetary benefit (NMB) and the cost per Quality Adjusted Life Years (QALYs) gained over a lifetime horizon.
Needle exchange services provided a 7.45-fold increase in detecting positive individuals and an incremental cost of £12,336 per QALY gained against current practice (NMB £163,827), making this the most cost-effective strategy over a lifetime horizon. Screening at substance misuse services and pharmacies was cost-effective only at a £30,000/QALY threshold. With a 24% discount to HCV treatment list prices, all three screening strategies become cost-effective at £20,000/QALY.
Targeting PWID populations with screening at needle exchange services is a highly cost-effective strategy for reaching undiagnosed HCV patients. When applying realistic discounts to list prices of drug treatments, all three strategies were highly cost-effective from a UK NHS perspective. All of these strategies have the potential to make a cost-effective contribution to the eradication of HCV by 2030.
在发达国家，注射毒品者（PWID）的丙型肝炎病毒（HCV）感染率很高，但他们往往未被诊断。世界卫生组织已将 2030 年定为 HCV 消除目标年。为了实现这一目标，在方便的社区环境中改善筛查，以发现感染但未确诊的个体，是当务之急。本研究评估了在 PWID 中诊断 HCV 感染的替代新策略的成本效益。
进行成本效益分析，以比较在针具交换中心、药物滥用服务机构和社区药房进行 HCV 筛查与在全科医生咨询中进行常规检测的情况。采用决策树模型评估每例阳性诊断的增量成本，并采用马尔可夫模型探讨终生范围内的净货币收益（NMB）和每获得 1 个质量调整生命年（QALY）的成本。
针具交换服务使阳性个体的检出率提高了 7.45 倍，与现行做法相比，每获得 1 个 QALY 的增量成本为 12,336 英镑（NMB 为 163,827 英镑），在终生范围内，这是最具成本效益的策略。在药物滥用服务和药房进行筛查，仅在 30,000 英镑/QALY 的阈值下具有成本效益。当将 HCV 治疗定价降低 24%时，所有三种筛查策略在 20,000 英镑/QALY 的阈值下都具有成本效益。
在针具交换服务中针对 PWID 人群进行筛查，是发现未确诊 HCV 患者的一种极具成本效益的策略。当对药物治疗的定价进行现实折扣后，从英国 NHS 的角度来看，所有三种策略都具有高度成本效益。所有这些策略都有可能为 2030 年消除 HCV 做出有成本效益的贡献。
