法国 HIV 合并感染男性人群中 HCV 检测及治疗和降低风险策略的成本效益分析。
Cost-effectiveness of hepatitis C virus test-and-treat and risk reduction strategies among men who have sex with men living with HIV in France.
机构信息
Université de Paris, IAME, INSERM, Paris, France.
Sorbonne Université, Inserm, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.
出版信息
J Int AIDS Soc. 2022 Dec;25(12):e26035. doi: 10.1002/jia2.26035.
INTRODUCTION
Studies suggest that hepatitis C virus (HCV) micro-elimination is feasible among men who have sex with men (MSM) living with human immunodeficiency virus (HIV), through treatment-as-prevention and interventions aimed at reducing risk behaviours. However, their economic impact is poorly understood. The aim of this study was to assess the cost-effectiveness of HCV screening and risk reduction strategies in France.
METHODS
A compartmental deterministic mathematical model was developed to describe HCV disease transmission and progression among MSM living with HIV in France. We evaluated different combinations of HCV screening frequency (every 12, 6 or 3 months) and risk reduction strategies (targeting only high-risk or all MSM) from 2021 onwards. The model simulated the number of HCV infections, life-expectancy (LYs), quality-adjusted life-expectancy (QALYs), lifetime costs and incremental cost-effectiveness ratio (ICER) over a lifetime horizon (leading to an end of the simulation in 2065).
RESULTS
All strategies increased QALYs, compared with current practices, that is yearly HCV screening, with no risk reduction. A behavioural intervention resulting in a 20% risk reduction in the high-risk group, together with yearly screening, was the least expensive strategy, and, therefore, cost-saving compared to current practices. The ICER per QALY gained for the strategy combining risk reduction for the high-risk group with 6-month HCV screening, compared to risk reduction with yearly screening, was €61,389. It also prevented 398 new HCV infections between 2021 and 2065, with a cost per infection averted of €37,790. All other strategies were dominated (more expensive and less effective than some other available alternative) or not cost-effective (ICER per QALY gained > €100,000).
CONCLUSIONS
In the French context, current HCV screening practices without risk reduction among MSM living with HIV cannot be justified on economic grounds. Risk reduction interventions targeted to high-risk individuals-alongside screening either once or twice a year-could be cost-effective depending on the policymaker's willingness-to-pay.
简介
研究表明，通过治疗即预防和旨在降低风险行为的干预措施，在感染人类免疫缺陷病毒（HIV）的男男性行为者（MSM）中，实现丙型肝炎病毒（HCV）的微小消除是可行的。然而，其经济影响尚不清楚。本研究旨在评估法国 HCV 筛查和降低风险策略的成本效益。
方法
我们开发了一个房室确定性数学模型，用于描述法国 HIV 感染者中 MSM 中的 HCV 疾病传播和进展。我们评估了从 2021 年开始，不同 HCV 筛查频率（每 12、6 或 3 个月）和降低风险策略（仅针对高风险或所有 MSM）组合的效果。该模型模拟了 HCV 感染数量、预期寿命（LYs）、质量调整预期寿命（QALYs）、终生成本和增量成本效益比（ICER），在一个生命周期（导致模拟在 2065 年结束）。
结果
与目前的做法相比，所有策略都增加了 QALYs，即每年进行 HCV 筛查，但没有降低风险。一种行为干预措施使高风险组的风险降低 20%，同时每年进行筛查，是最经济的策略，与目前的做法相比是节省成本的。与每年进行筛查相比，结合高风险组风险降低和每 6 个月进行 HCV 筛查的策略，每获得一个 QALY 的 ICER 为 61389 欧元。它还预防了 2021 年至 2065 年期间的 398 例新 HCV 感染，每例感染预防的成本为 37790 欧元。所有其他策略都处于劣势（更昂贵且效果不如其他一些可用替代方案）或不具有成本效益（每获得一个 QALY 的 ICER 超过 100000 欧元）。
结论
在法国背景下，目前在 HIV 感染者中对 MSM 进行无风险降低的 HCV 筛查不能从经济角度证明是合理的。针对高风险个体的风险降低干预措施——与每年筛查一次或两次相结合——可能具有成本效益，具体取决于决策者的支付意愿。
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