Assessment of the Feasibility and Cost of Hepatitis C Elimination in Pakistan
Assessment of the Feasibility and Cost of Hepatitis C Elimination in Pakistan
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DOI：
10.1001/jamanetworkopen.2019.3613
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发表时间：
2019-05-01
影响因子：
13.8
通讯作者：
Kanwal, Fasiha
中科院分区：
文献类型：
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作者：
Chhatwal, Jagpreet;Chen, Qiushi;Kanwal, Fasiha
慢性丙型肝炎病毒（HCV）感染是一个全球性的健康问题。世界卫生大会最近承诺到2030年消除丙型肝炎病毒。然而，在患病率最高的国家之一巴基斯坦，消除丙型肝炎病毒的可行性和成本尚不清楚。目的调查在巴基斯坦消除丙型肝炎病毒是否可行以及在什么条件下可行，并估计这种消除的成本。设计、环境和参与者本决策分析模型研究采用巴基斯坦2015年至2030年HCV流行的微观模拟模型。使用巴基斯坦特有的变量，该模型模拟了巴基斯坦丙型肝炎病毒的情况，并评估了在巴基斯坦消除丙型肝炎病毒所需的最低筛查和治疗率。该研究模拟了2015年至2030年间慢性丙型肝炎病毒感染者。该分析是在2018年进行的。干预措施现状和到2030年可能导致巴基斯坦消除丙型肝炎病毒的7种情况，这些情况是通过筛查、治疗前病毒血症检测和确认治疗反应的不同检测组合来确定的。主要结局和测量指标：HCV感染流行率、死亡率、残疾调整生命年和HCV感染治疗总成本在现状和2030年可消除HCV的情况下的时间趋势。结果在目前的情况下，2015 - 2030年预计将有144万人死于HCV感染；48%的死亡者将是50岁以下的人。为了在巴基斯坦实现消除丙型肝炎病毒的目标，丙型肝炎病毒检测需要扩大到至少2500万人，每年诊断90万人，治疗70万人。与现状相比，从2015年到2030年，消除丙型肝炎将避免32.3万例肝脏相关死亡和1300万例丙型肝炎相关残疾调整生命年。这一消除方案与2018年至2030年期间节省26亿美元的成本有关，因为使用了一种即时检测方法进行全民抗体筛查、检测病毒血症和治疗反应。结论和相关性：大规模扩大HCV检测和治疗可能对巴基斯坦消除HCV感染至关重要，而且这种策略可能在不久的将来节省成本。尽管在巴基斯坦消灭丙型肝炎病毒可能是雄心勃勃的，但战略规划和政府的大力支持可能有助于消灭丙型肝炎病毒。
IMPORTANCE Chronic hepatitis C virus (HCV) infection is a global health problem. The World Health Assembly recently pledged to eliminate HCV by 2030. However, in Pakistan, a country with one of the highest prevalence rates, the feasibility and cost of HCV elimination are not known.OBJECTIVES To investigate whether and under what conditions HCV elimination is feasible in Pakistan and to estimate the cost of such elimination.DESIGN, SETTING, AND PARTICIPANTS This decision analytical model study used a microsimulation model of the HCV epidemic in Pakistan from 2015 to 2030. Using Pakistan-specific variables, the model simulated the landscape of HCV in Pakistan and evaluated the minimum required screening and treatment rates needed to eliminate HCV in Pakistan. The study used simulated individuals chronically infected with HCV from 2015 to 2030. The analysis was performed in 2018.INTERVENTIONS The status quo and 7 scenarios that can lead to HCV elimination in Pakistan by 2030, which were defined by different combinations of tests for screening, detection of viremia before treatment, and confirmation of treatment response.MAIN OUTCOMES AND MEASURES Temporal trends in HCV infection prevalence, mortality, and disability-adjusted life-years and total cost of HCV infection care under the status quo and scenarios that can eliminate HCV by 2030.RESULTS Under the status quo, from 2015 to 2030, 1.44 million people are projected to die of HCV infection; 48% of deaths would be among people younger than 50 years. To achieve HCV elimination in Pakistan, HCV testing would need to be scaled up to at least 25 million people to diagnose 900 000 persons and treatment to 700 000 people per year. Compared with the status quo, the elimination scenario would avert 323 000 liver-related deaths and 13.0 million HCV-associated disability-adjusted life-years from 2015 to 2030. The elimination scenario was associated with cost savings of $2.6 billion from 2018 to 2030 with use of a point-of-care test for population-wide antibody screening and detection of viremia and treatment response.CONCLUSIONS AND RELEVANCE Substantial scale-up of HCV testing and treatment may be essential to eliminate HCV infection in Pakistan, and such a strategy may be associated with cost savings in the near future. Although HCV elimination in Pakistan may be ambitious, strategic planning and strong support from the government may aid in its elimination.