The cost-effectiveness of case-finding strategies for achieving hepatitis C elimination among men who have sex with men in the UK.
The cost-effectiveness of case-finding strategies for achieving hepatitis C elimination among men who have sex with men in the UK.
复制标题
在英国实现男男性行为者中消除丙型肝炎的病例发现策略的成本效益。
DOI：
10.1111/jvh.13503
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发表时间：
2021-06
影响因子：
2.5
通讯作者：
Vickerman, Peter
中科院分区：
文献类型：
--
作者：
Macgregor, Louis;Ward, Zoe;Martin, Natasha K.;Nicholls, Jane;Desai, Monica;Hickson, Ford;Weatherburn, Peter;Hickman, Matthew;Vickerman, Peter
关键词：
模型表明，丙型肝炎病毒（HCV）的消除是可能的男性与男性发生性关系（MSM），与关键的筛查组，包括艾滋病毒诊断的男男性行为者和男男性行为者使用暴露前预防（PrEP）。数学模型被用来确定从供应商的角度来看，在男男性接触者中的HCV病例发现策略的成本效益，并确定哪些干预措施可以在2015-2030年期间实现HCV发病率降低90%。在基线时，我们假设HIV阴性MSM（包括PrEP使用者）进行症状筛查，HIV诊断的MSM进行12个月的筛查。改进的病例发现策略包括在不使用PrEP的艾滋病毒阴性男男性行为者（PrEP非使用者）中进行筛查和艾滋病毒检测; PrEP使用者每月进行12/6/3次筛查;以及对诊断为艾滋病毒的男男性行为者进行6个月的筛查，成本效益进行增量比较。评估了成本（GBP）和质量调整生命年（QALY），以估计到2050年的平均增量成本效益比（ICER），与20，000英镑/QALY的支付意愿阈值相比。从基线开始，最具增量成本效益的策略是首先进行：（1）PrEP使用者的12个月HCV筛查（获得6，715个QALY，ICER为1，760英镑/QALY），其次是（2）PrEP非使用者的HCV筛查以及HIV检测（获得7，048个QALY，ICER为4，972英镑/QALY）。与基线相比，这种组合策略将花费4690万英镑（95%CrI 2530万-6690万英镑），并在100%的模型运行中实现HCV消除目标。与该组合策略相比，额外筛查导致ICER> 20，000英镑/QALY。在英国男男性接触者中，消除丙型肝炎病毒是具有成本效益的。政策制定者应考虑在艾滋病毒阴性的男男性行为者，特别是PrEP使用者中扩大HCV筛查，以实现这一目标。
Modelling suggests hepatitis C virus (HCV) elimination is possible among men-who-have-sex-with-men (MSM), with key screening groups including HIV-diagnosed MSM and MSM using pre-exposure prophylaxis (PrEP). Mathematical modelling was used to determine the cost-effectiveness of HCV case-finding strategies among MSM from the provider perspective, and to determine which interventions could achieve a 90% reduction in HCV incidence over 2015–2030. At baseline, we assume symptomatic screening in HIV-negative MSM (including PrEP users) and 12-monthly screening among HIV-diagnosed MSM. Improved case-finding strategies included screening alongside HIV-testing in HIV-negative MSM not using PrEP (PrEP non-users); 12/6/3-monthly screening in PrEP users; and 6-monthly screening in HIV-diagnosed MSM, with the cost-effectiveness being compared incrementally. Costs (GBP) and quality adjusted life-years (QALYs) were assessed to estimate the mean incremental cost-effectiveness ratio (ICER) with a time horizon to 2050, compared to a willingness-to-pay threshold of £20,000/QALY. From the baseline, the most incrementally cost-effective strategy is to firstly undertake: (1) 12-monthly HCV screening of PrEP users (gaining 6,715 QALYs with ICER £1,760/QALY), followed by (2) HCV screening among PrEP non-users alongside HIV testing (gaining 7,048 QALYs with ICER £4,972/QALY). Compared to the baseline, this combined strategy would cost £46.9 (95%CrI £25.3-£66.9) million and achieve the HCV elimination target in 100% of model runs. Additional screening incurs ICERs >£20,000/QALY compared to this combined strategy. HCV elimination can be achieved cost-effectively among UK MSM. Policymakers should consider scaling-up HCV screening in HIV-negative MSM, especially PrEP users, for achieving this target.
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影响因子：
2.5
作者：
Martin NK;Foster GR;Vilar J;Ryder S;Cramp ME;Gordon F;Dillon JF;Craine N;Busse H;Clements A;Hutchinson SJ;Ustianowski A;Ramsay M;Goldberg DJ;Irving W;Hope V;De Angelis D;Lyons M;Vickerman P;Hickman M
通讯作者：
Hickman M
影响因子：
6.7
作者：
Hezode, Christophe
通讯作者：
Hezode, Christophe
影响因子：
4.5
作者：
Marcus U;Hickson F;Weatherburn P;Schmidt AJ;EMIS Network
通讯作者：
EMIS Network
影响因子：
15.1
作者：
Macgregor, Louis;Desai, Monica;Vickerman, Peter
通讯作者：
Vickerman, Peter
影响因子：
16.1
作者：
Molina, Jean-Michel;Charreau, Isabelle;Meyer, Laurence
通讯作者：
Meyer, Laurence