Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, England, UK; The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, England, UK.
The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, England, UK; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, England, UK.
Value Health. 2020 Aug;23(8):1003-1011. doi: 10.1016/j.jval.2020.03.014. Epub 2020 Jul 14.
The prevalence of hepatitis is high in emergency department (ED) attendees in the United Kingdom, with a prevalence of up to 2% for hepatitis B (HBV) HBsAg, and 2.9% for hepatitis C (HCV) RNA. The aim of this paper is to perform an economic evaluation of opt-out ED-based HCV and HBV testing.
A Markov model was developed to analyze the cost-effectiveness of opt-out HCV and HBV testing in EDs in the UK. The model used data from UK studies of ED testing to parameterize the HCV and HBV prevalence (1.4% HCV RNA, 0.84% HBsAg), test costs, and intervention effects (contact rates and linkage to care). For HCV, we used an antibody test cost of £3.64 and RNA test cost of £68.38, and assumed direct-acting antiviral treatment costs of £10 000. For HBV, we used a combined HBsAg and confirmatory test cost of £5.79. We also modeled the minimum prevalence of HCV (RNA-positive) and HBV (HBsAg) required to make ED testing cost-effective at a £20 000 willingness to pay per quality-adjusted life-year threshold.
In the base case, ED testing was highly cost-effective, with HCV and HBV testing costing £8019 and £9858 per quality-adjusted life-year gained, respectively. HCV and HBV ED testing remained cost-effective at 0.25% HCV RNA or HBsAg prevalence or higher.
Emergency department testing for HCV and HBV is highly likely to be cost-effective in many areas across the UK depending on their prevalence. Ongoing studies will help evaluate ED testing across different regions to inform testing guidelines.
在英国，急诊科（ED）就诊者中肝炎的患病率很高，乙型肝炎（HBV）HBsAg 的患病率高达 2%，丙型肝炎（HCV）RNA 的患病率为 2.9%。本文旨在对基于 ED 的 HCV 和 HBV 检测的经济学评价进行研究。
采用 Markov 模型分析英国 ED 中基于选择的 HCV 和 HBV 检测的成本效益。该模型使用来自英国 ED 检测研究的数据来参数化 HCV 和 HBV 的患病率（HCV RNA 为 1.4%，HBsAg 为 0.84%）、检测成本和干预效果（接触率和护理衔接）。对于 HCV，我们使用了 3.64 英镑的抗体检测成本和 68.38 英镑的 RNA 检测成本，并假设直接作用抗病毒治疗的费用为 10000 英镑。对于 HBV，我们使用了 HBsAg 和确认检测的综合费用 5.79 英镑。我们还对 HCV（RNA 阳性）和 HBV（HBsAg）的最小患病率进行建模，以确定在 20000 英镑每质量调整生命年的意愿支付阈值下，ED 检测的成本效益。
在基础情况下，ED 检测具有很高的成本效益，HCV 和 HBV 检测分别使每质量调整生命年的成本增加 8019 英镑和 9858 英镑。HCV 和 HBV 的 ED 检测在 HCV RNA 或 HBsAg 的患病率为 0.25%或更高时仍然具有成本效益。
根据 HCV 和 HBV 的患病率，英国许多地区的 ED 检测对 HCV 和 HBV 进行检测很可能具有成本效益。正在进行的研究将有助于评估不同地区的 ED 检测，为检测指南提供信息。
