Digestive Medicine Section, Hospital Marina Baixa de la Vila Joiosa (Alicante), Marina Baixa de la Vila Hospital, Joiosa, Alicante, Spain.
Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain.
PLoS One. 2021 Dec 20;16(12):e0260608. doi: 10.1371/journal.pone.0260608. eCollection 2021.
Prevalence of chronic hepatitis C (CHC) is higher in patients born between 1955-1975. The aim was to perform an economic evaluation of an age-based electronic health record (EHR) alert in primary care to detect patients with undiagnosed CHC and its treatment in comparison with non-use of the alert system, in Valencian Community, Spain.
Decision trees and Markov model were used to evaluate the diagnosis and progression of the disease, respectively. CHC was diagnosed by serology and viral load in seropositive subjects. Epidemiological data and diagnostic costs were extracted from public sources of the Valencian Community. Probabilities, utilities and costs of model states were obtained from the literature. The impact on mortality and hepatic complications avoided by the implementation of the alert were estimated, and efficiency was measured as an incremental cost-utility ratio (ICUR) based on quality-adjusted life years (QALYs) and the costs of both alternatives.
The EHR alert detected 269,548 patients, of whom 1,331 had CHC (vs. 23 patients with non-alert). Over the patients' lifetime, the alert would prevent 93% of decompensated cirrhosis cases, 87% of hepatocellular carcinomas, 90% of liver transplants, and 89% of liver related deaths compared to non-use of the alert system. In addition, it would obtain an additional 3.3 QALY per patient, with an incremental cost of €10,880 and an ICUR of €3,321.
The implementation of an age-based EHR alert in primary care to detect patients with CHC reduces hepatic complications and mortality and is an efficient strategy.
1955 年至 1975 年间出生的患者慢性丙型肝炎（CHC）的患病率较高。本研究旨在对初级保健中基于年龄的电子健康记录（EHR）警报进行经济评估，以检测未确诊的 CHC 及其治疗方法，与不使用警报系统相比，该研究在西班牙巴伦西亚自治区进行。
决策树和马尔可夫模型分别用于评估疾病的诊断和进展。通过血清学和血清学阳性患者的病毒载量来诊断 CHC。流行病学数据和诊断成本从巴伦西亚自治区的公共资源中提取。模型状态的概率、效用和成本从文献中获得。通过实施警报避免的死亡率和肝脏并发症的影响进行了估计，并根据质量调整生命年（QALYs）和两种替代方案的成本，以增量成本-效用比（ICUR）衡量效率。
EHR 警报检测到 269548 名患者，其中 1331 名患有 CHC（与非警报患者相比）。在患者的一生中，与不使用警报系统相比，该警报将预防 93%的失代偿性肝硬化病例、87%的肝细胞癌、90%的肝移植和 89%的与肝脏相关的死亡。此外，它将为每位患者额外获得 3.3 个 QALY，增量成本为 10880 欧元，增量成本效益比（ICUR）为 3321 欧元。
在初级保健中实施基于年龄的 EHR 警报以检测 CHC 患者可减少肝脏并发症和死亡率，是一种有效的策略。
