Department of Gastroenterology, Health Sciences University Antalya Training and Research Hospital, Antalya, Turkey.
Department of Infectious Diseases and Clinical Microbiology, Ministry of Health Ankara City Hospital, Ankara, Turkey.
Turk J Gastroenterol. 2023 Oct;34(10):1062-1070. doi: 10.5152/tjg.2023.22749.
BACKGROUND/AIMS: In 2016, World Health Organization introduced global goals to eliminate hepatitis C virus by 2030. The aim of this study is to analyze the epidemiologic and economic burden of hepatitis C virus in Turkey and compare current practice (regular care) with a hypothetical active screening and treatment approach (active scenario).
A Markov model was used to analyze and compare regular care with a scenario developed by experts including the screening and treatment of all acute and chronic hepatitis C virus infections between 2020 and 2050. General and targeted populations were focused. The model reflected the natural history of the disease, and the inputs were based on a literature review and expert opinions. Costs were provided by previous studies and national regulations.
The active scenario resulted in higher spending for all groups compared with regular care in the first year. Cumulative costs were equalized in the 8th, 12th, 13th, and 16th year and followed by cost-savings of 49.7 million, 1.1 billion, 288.6 million, and 883.4 million Turkish liras in 20 years for prisoners, refugees, people who inject drugs (PWID), and all population, respectively. In all groups, the mortality was found to be lower with the active scenario. In total, 62.8% and 50.6% of expected deaths with regular care in 5 and 20 years, respectively, were prevented with the active scenario.
An active screening and treatment approach for hepatitis C virus infection could be cost-effective for PWID, prisoners, and refugees. Almost two-thirds of deaths in regular care could be prevented in 5 years' time with this approach.
背景/目的：2016 年，世界卫生组织提出了到 2030 年消除丙型肝炎病毒的全球目标。本研究旨在分析土耳其丙型肝炎病毒的流行病学和经济负担，并比较当前的实践（常规护理）与假设的主动筛查和治疗方法（主动方案）。
使用马尔可夫模型分析和比较常规护理与专家制定的方案，包括 2020 年至 2050 年期间所有急性和慢性丙型肝炎病毒感染的筛查和治疗。重点关注一般人群和目标人群。该模型反映了疾病的自然史，输入数据基于文献综述和专家意见。成本由先前的研究和国家法规提供。
与常规护理相比，主动方案在第一年所有组别的支出都更高。在第 8、12、13 和 16 年，累计成本达到平衡，随后在 20 年内，囚犯、难民、注射毒品者（PWID）和所有人群分别节省 4970 万、11 亿、2.886 亿和 8.834 亿土耳其里拉。在所有组中，主动方案的死亡率均较低。在常规护理下，预计在 5 年和 20 年内分别有 62.8%和 50.6%的死亡可通过主动方案预防。
对 PWID、囚犯和难民实施丙型肝炎病毒感染的主动筛查和治疗方法可能具有成本效益。在 5 年内，这种方法可预防常规护理中近三分之二的死亡。
