Cost-Effectiveness of a Core Antigen–Based Rapid Diagnostic Test for Hepatitis C
Cost-Effectiveness of a Core Antigen–Based Rapid Diagnostic Test for Hepatitis C
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基于核心抗原的丙型肝炎快速诊断测试的成本效益
DOI：
10.1016/j.jval.2022.01.004
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发表时间：
2022
期刊：
影响因子：
4.5
通讯作者：
Chhatwal, Jagpreet
中科院分区：
文献类型：
--
作者：
Adee, Madeline;Zhong, Huaiyang;Reipold, Elena Ivanova;Zhuo, Yueran;Shilton, Sonjelle;Chhatwal, Jagpreet
【摘要】目的丙型肝炎病毒（HCV）在全球感染了5800万人，其中有80%的人未被诊断出来。HCV快速诊断检测（RDTs）有助于提高诊断率和治疗率。然而，使用目前的HCV分子RDT方案所需的高昂价格和基础设施对广泛使用构成了障碍，特别是在低收入和中等收入国家。我们评估了理论核心抗原（cAg） RDT用于HCV病毒血症确认的性能和成本效益，该方法需要较少的资源。方法采用先前验证的微模拟模型来模拟格鲁吉亚和马来西亚不同HCV检测算法下的HCV疾病进展和结果。我们比较了基于实验室的核糖核酸HCV的护理标准检测和基于cag的RDT HCV确诊。我们模拟了每个国家1万名成年人的队列，格鲁吉亚的hcv -核糖核酸患病率为5.40%，马来西亚为1.54%。我们预测了累积医疗费用、质量调整生命年和诊断覆盖率。结果与标准护理测试相比，基于cag的RDT将使格鲁吉亚每10000人的质量调整生命年增加270年，马来西亚每10000人的质量调整生命年增加259年。基于cag的RDT的高诊断率和治疗率，避免了HCV后遗症的管理费用，从而节省了大量的费用。格鲁吉亚的成本节省为28.1万美元，马来西亚为78.1万美元。结论基于cag的HCV RDT可提高诊断率，节约成本。这样的检测可能对消除丙型肝炎病毒的可行性和成本产生重大影响。
Abstract Objectives Hepatitis C virus (HCV) affects 58 million worldwide and> 79% of people remain undiagnosed. Rapid diagnostic tests (RDTs) for HCV can help improve diagnosis and treatment rates. Nevertheless, the high price and infrastructure needed to use current molecular HCV RDT options present a barrier to widespread use—particularly in low-and middle-income countries. We evaluated the performance and cost-effectiveness of a theoretical core antigen (cAg) RDT for HCV viremia confirmation, which requires fewer resources. Methods We adapted a previously validated microsimulation model to simulate HCV disease progression and outcomes under different HCV testing algorithms in Georgia and Malaysia. We compared standard of care testing with laboratory-based ribonucleic acid HCV to a cAg-based RDT for HCV confirmation. We simulated a cohort of 10 000 adults in each country, with an HCV-ribonucleic acid prevalence of 5.40% in Georgia and 1.54% in Malaysia. We projected the cumulative healthcare costs, quality-adjusted life-years, and diagnosis coverage rates over a lifetime horizon. Results Compared with the standard of care testing, the cAg-based RDT would increase quality-adjusted life-years by 270 in Georgia and 259 in Malaysia per 10 000 people. The high diagnosis rate and treatment rate of the cAg-based RDT result in substantial cost savings because of averted HCV sequelae management costs. Cost savings are $281 000 for Georgia and $781 000 for Malaysia. Conclusions We found that a cAg-based RDT for HCV could improve the diagnosis rate and result in cost savings. Such a test could have a substantial impact on the feasibility and cost of HCV elimination.