Cost-Effectiveness of Hepatitis B Testing and Vaccination of Adults Seeking Care for Sexually Transmitted Infections.
Cost-Effectiveness of Hepatitis B Testing and Vaccination of Adults Seeking Care for Sexually Transmitted Infections.
复制标题
对寻求性传播感染护理的成年人进行B型肝炎检测和疫苗接种的成本效益。
DOI：
10.1097/olq.0000000000001632
复制
发表时间：
2022-07-01
影响因子：
3.1
通讯作者：
中科院分区：
文献类型：
--
作者：
对寻求评估和治疗性传播感染的成年人进行乙肝病毒检测，这些成年人没有接种疫苗，并且不知道自己的乙肝病毒感染状况，与目前仅接种疫苗的建议相比，节省了成本。2018年通过性传播获得的乙肝病毒(乙肝)感染者估计为10.3万人，估计每年新发病例8300例。尽管免疫实践咨询委员会建议求助性传播感染评估和治疗的人接种乙肝疫苗，但还不建议进行预防接种测试。筛查可以将慢性乙肝患者与护理和减少不必要的疫苗接种联系起来。我们使用马尔可夫模型来计算一次乙肝病毒检测结合第一剂乙肝疫苗对寻求STI治疗的成年人的健康影响和成本效益。我们对年龄在18岁到69岁之间的10万名假设人口进行了终生的社会视角分析。疾病进展的估计来自最近的队列研究和荟萃分析。在美国，每个质量调整生命年(QALY)的成本低于10万美元的干预通常被认为是具有成本效益的。比较的策略如下：(1)不筛查乙肝疫苗；(2)接种和筛查乙肝表面抗原；(3)接种和筛查乙肝表面抗原；(4)接种和筛查乙肝表面抗原和抗-HBc。数据来自医疗保险和医疗补助服务报销中心、疾病控制和预防中心疫苗价目表和其他成本效益文献。与目前的建议相比，增加一次性乙肝病毒检测节省了成本，每10万名筛查成年人将额外预防138例肝硬化、47例失代偿性肝硬化、90例肝细胞癌、33例肝移植和163例与乙肝相关的死亡，并增加2185个QALY。使用三测试板进行筛查将为每10万名接受检测的成年人节省4160万至4270万美元，相比之下，两测试板的筛查成本为4150万至4250万美元，仅乙肝表面抗原筛查的成本为4020万至4030万美元。除了为未接种乙肝疫苗的成年人接种乙肝疫苗外，对寻求STI护理的成年人进行一次性乙肝预防接种测试将挽救生命，防止新的感染和不必要的接种，而且节省成本。
Hepatitis B virus testing of adults seeking evaluation and treatment of sexually transmitted infection who are unvaccinated and do not know their hepatitis B virus infection status is cost saving compared with the current recommendation for vaccination alone. The estimated number of people living with hepatitis B virus (HBV) infection acquired through sexual transmission was 103,000 in 2018, with an estimated incidence of 8300 new cases per year. Although hepatitis B (HepB) vaccination is recommended by the Advisory Committee for Immunization Practices for persons seeking evaluation and treatment for sexually transmitted infections (STIs), prevaccination testing is not yet recommended. Screening may link persons with chronic hepatitis B to care and reduce unnecessary vaccination. We used a Markov model to calculate the health impact and cost-effectiveness of 1-time HBV testing combined with the first dose of the HepB vaccine for adults seeking care for STI. We ran a lifetime, societal perspective analysis for a hypothetical population of 100,000 aged 18 to 69 years. The disease progression estimates were taken from recent cohort studies and meta-analyses. In the United States, an intervention that costs less than $100,000 per quality-adjusted life-year (QALY) is generally considered cost-effective. The strategies that were compared were as follows: (1) vaccination without HBV screening, (2) vaccination and hepatitis B surface antigen (HBsAg) screening, (3) vaccination and screening with HBsAg and anti-HBs, and (4) vaccination and screening with HBsAg, anti-HBs, and anti-HBc. Data were obtained from Centers for Medicare & Medicaid services reimbursement, the Centers for Disease Control and Prevention vaccine price list, and additional cost-effectiveness literature. Compared with current recommendations, the addition of 1-time HBV testing is cost-saving and would prevent an additional 138 cases of cirrhosis, 47 cases of decompensated cirrhosis, 90 cases of hepatocellular carcinoma, 33 liver transplants, and 163 HBV-related deaths, and gain 2185 QALYs, per 100,000 adults screened. Screening with the 3-test panel would save $41.6 to $42.7 million per 100,000 adults tested compared with $41.5 to $42.5 million for the 2-test panel and $40.2 to $40.3 million for HBsAg alone. One-time HBV prevaccination testing in addition to HepB vaccination for unvaccinated adults seeking care for STI would save lives and prevent new infections and unnecessary vaccination, and is cost-saving.