Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.
Optimal control of hepatitis C antiviral treatment programme delivery for prevention amongst a population of injecting drug users.
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DOI：
10.1371/journal.pone.0022309
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发表时间：
2011
期刊：
影响因子：
3.7
通讯作者：
Hickman M
中科院分区：
文献类型：
--
作者：
Martin NK;Pitcher AB;Vickerman P;Vassall A;Hickman M
在大多数发达国家，丙型肝炎病毒主要由注射吸毒者传播。丙型肝炎病毒抗病毒治疗是有效的，并且对于那些没有再感染风险的人来说被认为是具有成本效益的。然而，目前治疗的有效静脉注射药物很少。先前的模型研究表明，对活动性注射吸毒者进行抗病毒治疗可以降低丙型肝炎病毒的患病率，并且人们对制定有针对性的注射吸毒者治疗方案越来越感兴趣。然而，考虑到卫生规划普遍存在的现实限制因素，治疗的最佳时机和规模尚不清楚。我们探讨了最佳规划如何受到各种政策目标、预算限制和流行情况的影响。我们开发了活跃注射吸毒者中丙型肝炎病毒传播和治疗的模型，确定了10年内两种慢性丙型肝炎病毒基线患病率情景（30%和45%）的最佳治疗规划策略，一系列最高年度预算（每1,000注射吸毒者50,000-300,000），以及各种目标：最大限度地减少卫生服务成本和卫生效用损失；在10岁时将患病率降至最低；制定最终流行率目标，尽量减少保健服务成本和保健效用损失；以最终流行率目标最小化卫生服务成本，但忽视卫生效用损失。给定预算允许的最大规划是将10年流行率和丙型肝炎病毒卫生效用损失和卫生服务成本降至最低的规划，预算越高，成本效益越高（以与未治疗相比获得的每质量质量质量成本衡量）。然而，如果目标是在10年内实现相对患病率降低20%，同时尽量减少卫生服务成本和卫生效用损失，最佳治疗策略是在5-8年内立即扩大覆盖范围，但成本效益较低。相反，如果目标只是尽量减少保健服务的费用，同时实现将流行率降低20%的目标，则该方案将推迟到本十年的最后几年实施，这是所有方案中成本效益最低的方案。
In most developed countries, HCV is primarily transmitted by injecting drug users (IDUs). HCV antiviral treatment is effective, and deemed cost-effective for those with no re-infection risk. However, few active IDUs are currently treated. Previous modelling studies have shown antiviral treatment for active IDUs could reduce HCV prevalence, and there is emerging interest in developing targeted IDU treatment programmes. However, the optimal timing and scale-up of treatment is unknown, given the real-world constraints commonly existing for health programmes. We explore how the optimal programme is affected by a variety of policy objectives, budget constraints, and prevalence settings. We develop a model of HCV transmission and treatment amongst active IDUs, determine the optimal treatment programme strategy over 10 years for two baseline chronic HCV prevalence scenarios (30% and 45%), a range of maximum annual budgets (50,000–300,000 per 1,000 IDUs), and a variety of objectives: minimising health service costs and health utility losses; minimising prevalence at 10 years; minimising health service costs and health utility losses with a final time prevalence target; minimising health service costs with a final time prevalence target but neglecting health utility losses. The largest programme allowed for a given budget is the programme which minimises both prevalence at 10 years, and HCV health utility loss and heath service costs, with higher budgets resulting in greater cost-effectiveness (measured by cost per QALY gained compared to no treatment). However, if the objective is to achieve a 20% relative prevalence reduction at 10 years, while minimising both health service costs and losses in health utility, the optimal treatment strategy is an immediate expansion of coverage over 5–8 years, and is less cost-effective. By contrast, if the objective is only to minimise costs to the health service while attaining the 20% prevalence reduction, the programme is deferred until the final years of the decade, and is the least cost-effective of the scenarios.
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影响因子：
4.5
作者：
Corluka A;Walker DG;Lewin S;Glenton C;Scheel IB
通讯作者：
Scheel IB
影响因子：
56.9
作者：
Blower, SM;Gershengorn, HB;Grant, RM
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Grant, RM
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2.5
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Poynard, T
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Annett, Hugh
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