Han Ru, Liang Shuyao, François Clément, Aballea Samuel, Clay Emilie, Toumi Mondher
Public Health Department - Research Unit, University of Aix-Marseille, Marseille, France.
HEOR, Creativ-Ceutical, Paris, France.
J Mark Access Health Policy. 2021 Mar 25;9(1):1887664. doi: 10.1080/20016689.2021.1887664.
Although the treatment of chronic hepatitis C (CHC) has significantly evolved with the introduction of direct-acting antivirals, the treatment uptake rates have been low especially among marginalized groups in the UK, such as people who inject drug (PWID) and men who have sex with men (MSM). Cutting health inequality is a major focus of healthcare agencies. This study aims to identify the optimal allocation of treatment budget for chronic hepatitis CHC among populations and treatments in the UK so that liver-related mortality in patients with CHC is minimized, given the constraint of treatment budget and equity issue. A constrained optimization modelling of resource allocation for the treatment of CHC was developed in Excel from the perspective of the UK National Health System over a lifetime horizon. The model was designated with the objective function of minimizing liver-related deaths by varying the decision variables, representing the number of patients receiving each treatment (elbasvir-grazoprevir, ombitasvir-paritaprevir-ritonavir-dasabuvir, sofosbuvir-ledipasvir, and pegylated interferon-ribavirin) in each population (the general population, PWID, and MSM). Two main constraints were formulated including treatment budget and the issue of equity. The model was populated with UK local data applying linear programming and underwent internal and external validation. Scenario analyses were performed to assess the robustness of model results. Within the constraints of no additional funding over original spending in status quo and the consideration of the issue of equity among populations, the optimal allocation from the constrained optimization modelling (treating 13,122 PWID, 160 MSM, and 904 general patients with ombitasvir-paritaprevir-ritonavir-dasabuvir) was found to treat 2,430 more patients (relative change: 20.7%) and avert 78 liver-related deaths (relative change: 0.3%) compared with the current allocation. The number of patients receiving treatment increased 4,928 (relative change: 60.1%) among PWID and 42 (relative change: 35.8%) among MSM. The current allocation of treatment budget for CHC is not optimal in the UK. More patients would be treated, and more liver-related deaths would be avoided using a new allocation from a constrained optimization modelling without incurring additional spending and considering the issue of equity.
尽管随着直接作用抗病毒药物的引入，慢性丙型肝炎（CHC）的治疗有了显著进展，但在英国，治疗的接受率一直很低，尤其是在边缘化群体中，如注射吸毒者（PWID）和男男性行为者（MSM）。减少健康不平等是医疗机构的一个主要重点。本研究旨在确定在英国不同人群和治疗方案中，慢性丙型肝炎治疗预算的最优分配，以便在治疗预算和公平问题的限制下，将丙型肝炎患者的肝脏相关死亡率降至最低。从英国国家医疗服务体系的角度出发，在Excel中建立了一个用于丙型肝炎治疗资源分配的约束优化模型，时间跨度为一生。该模型的目标函数是通过改变决策变量来最小化肝脏相关死亡人数，决策变量代表每个群体（普通人群、PWID和MSM）中接受每种治疗（艾尔巴韦-格拉瑞韦、奥比他韦-帕利瑞韦-利托那韦-达沙布韦、索磷布韦-维帕他韦和聚乙二醇干扰素-利巴韦林）的患者数量。制定了两个主要约束条件，包括治疗预算和公平问题。该模型使用英国当地数据，应用线性规划，并进行了内部和外部验证。进行了情景分析以评估模型结果的稳健性。在不超过现状原始支出的额外资金约束以及考虑人群公平问题的情况下，发现约束优化模型的最优分配（用奥比他韦-帕利瑞韦-利托那韦-达沙布韦治疗13122名PWID、160名MSM和904名普通患者）比当前分配多治疗2430名患者（相对变化：20.7%），并避免78例肝脏相关死亡（相对变化：0.3%）。在PWID中接受治疗的患者数量增加了4928名（相对变化：60.1%），在MSM中增加了42名（相对变化：35.8%）。在英国，目前丙型肝炎治疗预算的分配并非最优。在不产生额外支出并考虑公平问题的情况下，使用约束优化模型的新分配方案可以治疗更多患者，并避免更多肝脏相关死亡。
