The cost‐effectiveness of screening and treatment for hepatitis C in prisons in England and Wales: a cost‐utility analysis
The cost‐effectiveness of screening and treatment for hepatitis C in prisons in England and Wales: a cost‐utility analysis
复制标题
英格兰和威尔士监狱丙型肝炎筛查和治疗的成本效益：成本效用分析
作者：
Andrew Sutton;A. Sutton;W. Edmunds;M. Sweeting;O. Gill
摘要：在英格兰和威尔士以及世界上许多地方，与一般人群相比，囚犯丙型肝炎病毒（HCV）感染的流行率很高。 这是因为监狱人口中存在大量从事可能传播丙型肝炎病毒行为的注射毒品使用者。因此，建议监狱可能是进行丙型肝炎病毒筛查和治疗的合适地点。使用成本效用分析，本研究考虑了在监狱接收时对所有个人进行单轮筛查的成本和收益，然后在社区进行可能的后期筛查，并将其与仅在社区进行测试和治疗的个人进行比较。一轮监狱测试和治疗的成本/QALY被认为是54，852英镑，尽管概率敏感性分析显示这一估计存在很大的不确定性。单向敏感性分析揭示了描述慢性HCV进展的参数和折扣率的重要性。虽然在基线上呈现的结果表明，在监狱中筛查和治疗HCV并不具有成本效益，但这些结果存在很大的不确定性。描述慢性HCV进展的比率对这种干预的成本效益的重要性已经得到证明，这表明未来的工作应该进一步深入了解个人进展到慢性HCV感染后期的比率。
Summary. Prisoners have a high prevalence of hepatitis C virus (HCV) infection compared with the general population in England and Wales and in many locations throughout the world. This is because of large numbers of injecting drug users that engage in behaviours likely to transmit HCV being present within prison populations. It is, therefore, suggested that prison may be an appropriate location for HCV screening and treatment to be administered. Using cost‐utility analysis, this study considers the costs and benefits of administering a single round of screening on reception into prison to all individuals followed by possible later screening in the community and comparing this to individuals who may only be tested and treated in the community at a later date. The cost/QALY of one round of prison testing and treatment was found to be £54,852, although probabilistic sensitivity analysis showed extensive uncertainty about this estimate. One‐way sensitivity analysis revealed the importance of the parameters describing the progression of chronic HCV and the discount rates. While the results presented here at baseline would suggest that screening and treatment for HCV in prisons is not cost‐effective, these results are subject to much uncertainty. The importance of the rates describing the progression of chronic HCV on the cost‐effectiveness of this intervention has been demonstrated and this suggests that future work should be undertaken to gain further insight into the rates that individuals progress to the later stages of chronic HCV infection.