优化澳大利亚丙型肝炎病毒感染诊断和治疗的即时检测策略：基于模型的成本效益分析
Optimizing point-of-care testing strategies for diagnosis and treatment of hepatitis C virus infection in Australia: a model-based cost-effectiveness analysis.
作者信息
Shih Sophy T F, Cheng Qinglu, Carson Joanne, Valerio Heather, Sheehan Yumi, Gray Richard T, Cunningham Evan B, Kwon Jisoo A, Lloyd Andrew R, Dore Gregory J, Wiseman Virginia, Grebely Jason
机构信息
The Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney 2052, Australia.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
出版信息
Lancet Reg Health West Pac. 2023 Apr 4;36:100750. doi: 10.1016/j.lanwpc.2023.100750. eCollection 2023 Jul.
BACKGROUND
Timely diagnosis and treatment of hepatitis C virus (HCV) is critical to achieve elimination goals. This study evaluated the cost-effectiveness of point-of-care testing strategies for HCV compared to laboratory-based testing in standard-of-care.
METHODS
Cost-effectiveness analyses were undertaken from the perspective of Australian Governments as funders by modelling point-of-care testing strategies compared to standard-of-care in needle and syringe programs, drug treatment clinics, and prisons. Point-of-care testing strategies included immediate point-of-care HCV RNA testing and combined point-of-care HCV antibody and reflex RNA testing for HCV antibody positive people (with and without consideration of previous treatment). Sensitivity analyses were performed to investigate the cost per treatment initiation with different testing strategies at different HCV antibody prevalence levels.
FINDINGS
The average costs per HCV treatment initiation by point-of-care testing, from A$890 to A$1406, were up to 35% lower compared to standard-of-care ranging from A$1248 to A$1632 depending on settings. The average costs per treatment initiation by point-of-care testing for three settings ranged from A$1080 to A$1406 for RNA, A$960-A$1310 for combined antibody/RNA without treatment history consideration, and A$890-A$1189 for combined antibody/RNA with treatment history consideration. When HCV antibody prevalence was <74%, combined point-of-care HCV antibody and point-of-care RNA testing were the most cost-effective strategies. Modest increases in treatment uptake by 8%-31% were required for immediate point-of-care HCV RNA testing to achieve equivalent cost per treatment initiation compared to standard-of-care.
INTERPRETATION
Point-of-care testing is more cost-effective than standard of care for populations at risk of HCV. Testing strategies combining point-of-care HCV antibody and RNA testing are likely to be cost-effective in most settings.
FUNDING
National Health and Medical Research Council.
背景
丙型肝炎病毒（HCV）的及时诊断和治疗对于实现消除目标至关重要。本研究评估了即时检测策略相对于标准治疗中基于实验室检测的丙型肝炎病毒成本效益。
方法
从澳大利亚政府作为资助者的角度进行成本效益分析，通过对即时检测策略与针头和注射器项目、药物治疗诊所及监狱中的标准治疗进行建模。即时检测策略包括即时即时丙型肝炎病毒RNA检测以及对丙型肝炎病毒抗体呈阳性者（无论是否考虑既往治疗）进行丙型肝炎病毒抗体和反射性RNA联合即时检测。进行敏感性分析以研究在不同丙型肝炎病毒抗体流行率水平下不同检测策略的每次治疗启动成本。
结果
即时检测每次丙型肝炎病毒治疗启动的平均成本为890澳元至1406澳元，与标准治疗相比低35%，标准治疗成本根据不同环境在1248澳元至1632澳元之间。三种环境下即时检测每次治疗启动的平均成本，RNA检测为1080澳元至1406澳元，不考虑治疗史的抗体/RNA联合检测为960澳元至1310澳元，考虑治疗史的抗体/RNA联合检测为890澳元至1189澳元。当丙型肝炎病毒抗体流行率<74%时，丙型肝炎病毒抗体即时检测和即时RNA检测联合是最具成本效益的策略。即时丙型肝炎病毒RNA检测需要将治疗接受率适度提高8%-31%，才能实现与标准治疗相当的每次治疗启动成本。
解读
即时检测对于有丙型肝炎病毒感染风险的人群比标准治疗更具成本效益。丙型肝炎病毒抗体和RNA联合检测策略在大多数情况下可能具有成本效益。
资助
国家卫生与医学研究委员会。
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