Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.
Department of Emergency Medicine, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
BMC Health Serv Res. 2024 Oct 30;24(1):1308. doi: 10.1186/s12913-024-11793-4.
In the United States (US), hepatitis C virus (HCV) screening is not covered by payers in settings outside of primary care. A non-traditional, emergency department (ED)-based HCV screening program can be cost-effective and identify infection in vulnerable populations with a high HCV risk. This study examined the long-term cost-effectiveness of routine HCV screening and linkage-to-care for high-risk patients in the ED from the payer's perspective.
The University of Illinois Hospital and Health Sciences System (UIH) implemented Project HEAL (HIV & HCV Screening, Education, Awareness, Linkage-to-Care). Under this initiative, patients who presented to the ED received opt-out HCV screening if they were at high risk for HCV infection (birth cohort between 1945 and 1964, persons who inject drugs, and HIV infection) with subsequent linkage-to-care if infected. Using the summary data from Project HEAL, a hybrid decision-analytic Markov model was developed based on the HCV screening procedure in the ED and the natural history of HCV. A 30-year time horizon and 1-year cycle length were used. All patients who received the ED-based HCV screening were referred for treatment with direct-acting antiviral (DAA) regardless of their fibrosis stage.
When unscreened/untreated patients received DAA treatment at F1, F2, F3, and compensated cirrhosis stages, the incremental cost-effectiveness ratio (ICER) ranged from $6,084 to $77,063 per quality-adjusted life year (QALY) gained. When unscreened/untreated patients received DAA treatment at the decompensated cirrhosis stage, no HCV screening was dominated.
ED-based HCV screening and linkage-to-care was cost-effective at the willingness-to-pay (WTP) threshold of $100,000/QALY in all scenarios. A reduction in infected persons in the community may provide additional benefits not evaluated in this study.
在美国（US），除了初级保健之外，支付者不覆盖在其他环境下的丙型肝炎病毒（HCV）筛查。一种非传统的、基于急诊部（ED）的 HCV 筛查方案可以具有成本效益，并识别出高危人群中的 HCV 感染。本研究从支付者的角度考察了 ED 中高危人群常规 HCV 筛查和与护理的关联的长期成本效益。
伊利诺伊大学医院和健康科学系统（UIH）实施了 Project HEAL（HIV & HCV 筛查、教育、意识、与护理的关联）。在这项倡议下，在 ED 就诊的具有 HCV 感染高危风险的患者（1945 年至 1964 年出生队列、注射毒品者和 HIV 感染者）接受 HCV 筛查，如感染则进行与护理的关联。利用 Project HEAL 的汇总数据，根据 ED 中的 HCV 筛查程序和 HCV 的自然史，建立了一个混合决策分析马尔可夫模型。使用了 30 年的时间范围和 1 年的周期长度。所有接受 ED 基于 HCV 筛查的患者均被转诊接受直接作用抗病毒（DAA）治疗，无论其纤维化阶段如何。
当未筛查/未治疗的患者在 F1、F2、F3 和代偿性肝硬化阶段接受 DAA 治疗时，增量成本效益比（ICER）在每获得 1 个质量调整生命年（QALY）的 6084 美元至 77063 美元之间。当未筛查/未治疗的患者在失代偿性肝硬化阶段接受 DAA 治疗时，无 HCV 筛查是主导的。
在所有情况下，ED 基于 HCV 筛查和与护理的关联在支付意愿（WTP）阈值为 100000 美元/QALY 时具有成本效益。在本研究中未评估的社区中感染人数的减少可能会带来额外的益处。
