Malaisamy Muniyandi, Nagarajan Karikalan, Kirti Tyagi, Malkeet Singh, Venkatesan Prakash, Senthilkumar S, Sananthya Karthikeyan, Rajendran Krishnan, Kavitha Rajsekar, Vivekanandan Shanmugam, Selvavinayagam T S
Department of Health Economics, ICMR-National Institute for Research in Tuberculosis, New Delhi, India.
Department of Health Research, Ministry of Health and Family Welfare, New Delhi, India.
J Glob Infect Dis. 2021 Aug 31;13(3):126-132. doi: 10.4103/jgid.jgid_394_20. eCollection 2021 Jul-Sep.
Viral hepatitis is a crucial public health problem in India. Hepatitis C virus (HCV) elimination is a national priority and a key strategy has been adopted to strengthen the HCV diagnostics services to ensure early and accurate diagnosis.
To conduct an economic evaluation of implementing a rapid point-of-care screening test for the identification of HCV among the selected key population under the National Viral Hepatitis Control Programme in Tamil Nadu, South India. Economic evaluation of a point-of-care screening test for HCV diagnosis among the key population attending the primary health care centers. A combination of decision tree and Markov model was developed to estimate cost-effectiveness of point-of-care screening test for HCV diagnosis at the primary health care centers. Total costs, quality-adjusted life years (QALYs) of the intervention and comparator, and incremental cost-effectiveness ratio (ICER) were calculated. The model parameter uncertainties which would influence the cost-effectiveness outcome has been evaluated by one-way sensitivity analysis and probabilistic sensitivity analysis.
When compared to the tertiary level diagnostic strategy for HCV, the point-of-care screening for selected key population at primary health care level results in a gain of 57 undiscounted QALYs and 38 discounted QALYs, four undiscounted life years and two discounted life years. The negative ICER of the new strategy indicates that it is less expensive and more effective compared with the current HCV diagnosis strategy.
The proposed strategy for HCV diagnosis in the selected key population in Tamil Nadu is dominant and cost-saving compared to the current strategy.
病毒性肝炎是印度一个至关重要的公共卫生问题。丙型肝炎病毒（HCV）消除是一项国家优先事项，并且已采取一项关键战略来加强HCV诊断服务，以确保早期和准确诊断。
对在印度南部泰米尔纳德邦国家病毒性肝炎控制计划下为选定重点人群实施快速即时检测以识别HCV进行经济评估。对在初级卫生保健中心就诊的重点人群中用于HCV诊断的即时检测进行经济评估。开发了决策树和马尔可夫模型的组合，以估计初级卫生保健中心用于HCV诊断的即时检测的成本效益。计算了干预措施和对照措施的总成本、质量调整生命年（QALYs）以及增量成本效益比（ICER）。通过单向敏感性分析和概率敏感性分析评估了会影响成本效益结果的模型参数不确定性。
与HCV的三级诊断策略相比，在初级卫生保健层面为选定重点人群进行即时检测可带来57个未贴现QALYs和38个贴现QALYs的收益，4个未贴现生命年和2个贴现生命年。新策略的负ICER表明，与当前的HCV诊断策略相比，它成本更低且更有效。
与当前策略相比，泰米尔纳德邦选定重点人群中提议的HCV诊断策略具有优势且节省成本。
