Cost-effectiveness and Budgetary Impact of Hepatitis C Virus Testing, Treatment, and Linkage to Care in US Prisons
Cost-effectiveness and Budgetary Impact of Hepatitis C Virus Testing, Treatment, and Linkage to Care in US Prisons
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DOI：
10.1093/cid/ciz383
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发表时间：
2020-04-01
影响因子：
11.8
通讯作者：
Linas, Benjamin P.
中科院分区：
文献类型：
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作者：
Assoumou, Sabrina A.;Tasillo, Abriana;Linas, Benjamin P.
背景监狱中丙型肝炎病毒检测和治疗的接受率仍然很低。我们的目的是估计临床结果，成本效益（CE）和预算影响（BI）的HCV检测和治疗在美国（US）监狱或链接到释放时的护理。我们使用基于个人的模拟建模与医疗保健和惩教部（DOC）的CE和BI分析的角度来看，分别。我们使用已发表的数据和华盛顿州DOC个人水平的数据模拟了一个美国监狱队列。我们考虑了检测的排列（基于风险因素，入组或放行时的常规检测，无检测）、治疗（如果肝纤维化分期=F3，所有HCV感染或无治疗）和与护理的联系（放行或无联系）。结果包括质量调整生命年（QALY）;病例识别、治疗和治愈;避免肝硬化病例;增量成本效益比; DOC成本（2016年美元）;以及BI（医疗保健成本/监狱进入者）以推广到其他州。与“无检测、无治疗、无护理联系”相比，“全部检测、全部治疗、释放时护理联系”模式使终身持续病毒学应答增加了23%，使肝硬化病例减少了54%，DOC每年额外费用为每名囚犯1440美元，具有成本效益。在目前的药物价格下，靶向检测和基于肝纤维化的治疗以更高的成本提供更差的结果，或者以更高的成本获得更差的结果。在敏感性分析中，纤维化为基础的治疗限制在以前较高的药物成本是成本效益。尽管费用昂贵，但在监狱中广泛进行检测和治疗被认为在目前的药物价格下是很有价值的。
Background. Hepatitis C virus (HCV) testing and treatment uptake in prisons remains low. We aimed to estimate clinical outcomes, cost-effectiveness (CE), and budgetary impact (BI) of HCV testing and treatment in United States (US) prisons or linkage to care at release.Methods. We used individual-based simulation modeling with healthcare and Department of Corrections (DOC) perspectives for CE and BI analyses, respectively. We simulated a US prison cohort at entry using published data and Washington State DOC individual-level data. We considered permutations of testing (risk factor based, routine at entry or at release, no testing), treatment (if liver fibrosis stage =F3, for all HCV infected or no treatment), and linkage to care (at release or no linkage). Outcomes included quality-adjusted life-years (QALY); cases identified, treated, and cured; cirrhosis cases avoided; incremental cost-effectiveness ratios; DOC costs (2016 US dollars); and BI (healthcare cost/prison entrant) to generalize to other states.Results. Compared to "no testing, no treatment, and no linkage to care," the "test all, treat all, and linkage to care at release" model increased the lifetime sustained virologic response by 23%, reduced cirrhosis cases by 54% at a DOC annual additional cost of $1440 per prison entrant, and would be cost-effective. At current drug prices, targeted testing and liver fibrosis-based treatment provided worse outcomes at higher cost or worse outcomes at higher cost per QALY gained. In sensitivity analysis, fibrosis-based treatment restrictions were cost-effective at previous higher drug costs.Conclusions. Although costly, widespread testing and treatment in prisons is considered to be of good value at current drug prices.