Cost-effectiveness of the HepCATT intervention in specialist drug clinics to improve case-finding and engagement with HCV treatment for people who inject drugs in England.
Cost-effectiveness of the HepCATT intervention in specialist drug clinics to improve case-finding and engagement with HCV treatment for people who inject drugs in England.
复制标题
HepCATT 干预专科药物诊所的成本效益，以改善英格兰注射吸毒者的病例发现和 HCV 治疗参与。
DOI：
10.1111/add.14978
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Vickerman,Peter
中科院分区：
文献类型：
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作者：
Ward,Zoe;Reynolds,Rosie;Campbell,Linda;Martin,NatashaK;Harrison,Graham;Irving,William;Hickman,Matthew;Vickerman,Peter
背景和目标注射吸毒者（PWID）是丙型肝炎病毒（HCV）感染的高危人群；然而，在英格兰，约 50% 的患者未得到诊断，且与护理的联系很差。本研究调查了与英格兰药物治疗中心的标准护理途径相比，改善病例发现和转诊 HCV 治疗的干预措施 (HepCATT) 的成本效益。从医疗保健角度进行成本效益分析，设计 HCV 传播和疾病进展模型。 HepCATT 研究的主要结果和成本数据参数化了干预措施，表明 HepCATT 将药物治疗中心的 HCV 检测增加了 2.5 倍，并将 HCV 治疗途径的参与度增加了 10 倍。使用模型来估计自 2016 年以来 HCV 感染和 HCV 相关死亡的减少情况，并跟踪 50 多年的成本和健康效益（质量调整生命年或 QALY）。进行了单变量和概率敏感性分析 (PSA)。设置英格兰特有的流行病，注射吸毒者中慢性丙型肝炎患病率为 40%。参与者注射吸毒者到戒毒治疗中心进行干预。戒毒治疗中心的护士协调员改善从丙型肝炎病例发现到转诊和与专科护理联系的丙型肝炎护理途径。比较器是标准护理 HCV 护理路径。测量通过改进病例发现获得的每个 QALY 成本的增量成本效益比 (ICER)。调查结果在 50 年的时间里，每 1000 名注射吸毒者，HepCATT 干预可以预防 75 例（95% 中心区间 37-129）例死亡和 1330 例（827-2040）例死亡或 51% (30-67%) 所有新感染病例。每获得 QALY 的平均 ICER 为 7986 英镑，所有 PSA 模拟在每 QALY 支付意愿门槛为 20 000 英镑时都是具有成本效益的。单变量敏感性分析表明，如果 HCV 治疗成本降低至 3900 英镑，干预措施将节省成本。如果扩大到英格兰所有注射吸毒者，干预措施将花费 880 万英镑，到 2030 年将发病率降低 56% (33-70%)。 结论 增加戒毒治疗中心的丙型肝炎病毒感染病例发现和治疗转诊可能是降低注射吸毒者丙型肝炎病毒发病率的一项极具成本效益的策略。
Background and AimsPeople who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage‐to‐care is poor. This study investigated the cost‐effectiveness of an intervention (HepCATT) to improve case‐finding and referral to HCV treatment compared with standard‐of‐care pathways in drug treatment centres in England.DesignHCV transmission and disease progression model with cost‐effectiveness analysis using a health‐care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5‐fold and engagement onto the HCV treatment pathway 10‐fold. A model was used to estimate the decrease in HCV infections and HCV‐related deaths from 2016, with costs and health benefits (quality‐adjusted life‐years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken.SettingEngland‐specific epidemic with 40% prevalence of chronic HCV among PWID.ParticipantsPWID attending drug treatment centres.InterventionNurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case‐finding to referral and linkage to specialist care. Comparator was the standard‐of‐care HCV care pathway.MeasurementsIncremental cost‐effectiveness ratio (ICER) in terms of cost per QALY gained through improved case‐finding.FindingsOver 50 years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37–129) deaths and 1330 (827–2040) or 51% (30–67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost‐effective at a £20 000 per QALY willingness‐to‐pay threshold. Univariable sensitivity analyses suggest the intervention would become cost‐saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33–70%) by 2030.ConclusionsIncreasing hepatitis C virus infection case‐finding and treatment referral in drug treatment centres could be a highly cost‐effective strategy for decreasing hepatitis C virus incidence among people who inject drugs.