Is increased hepatitis C virus case-finding combined with current or 8-week to 12-week direct-acting antiviral therapy cost-effective in UK prisons? A prevention benefit analysis.
Is increased hepatitis C virus case-finding combined with current or 8-week to 12-week direct-acting antiviral therapy cost-effective in UK prisons? A prevention benefit analysis.
复制标题
DOI：
10.1002/hep.28497
复制
发表时间：
2016-06
期刊：
影响因子：
--
通讯作者：
Hickman M
中科院分区：
文献类型：
--
作者：
Martin NK;Vickerman P;Brew IF;Williamson J;Miners A;Irving WL;Saksena S;Hutchinson SJ;Mandal S;O'Moore E;Hickman M
囚犯的丙型肝炎病毒（HCV）流行率很高，但病例调查可能并不具有成本效益，因为治疗往往超过平均监禁时间，加上缺乏连续护理。我们评估的成本效益增加丙型肝炎病例发现和治疗在英国监狱使用短期治疗。动态HCV传播模型评估了加倍HCV病例发现（通过在英国试点监狱引入选择退出HCV检测实现）和增加英国监狱治疗的成本效益，与现状自愿基于风险的检测（6%监狱进入者/年）相比，使用目前推荐的治疗（8-24周）或无IFN的DAA（8-12周，95% SVR，3300英镑/周）。使用成本（GBP£）和健康效用（质量调整生命年，QELS）计算平均增量成本效果比（ICER）。我们假设56%的转介和2.5%/25%的转介注射毒品（PWID）/前PWID在监狱诊断后2个月内接受治疗。PWID和前/非PWID分别平均入狱4/8个月。与目前的测试/治疗相比，将现有治疗的监狱测试率提高一倍，平均ICER为19，850英镑/QALY，并且在20，000英镑的支付意愿（WTP）阈值下，有45%的可能性具有成本效益。在监狱中改用8-12周无干扰素的DAA可以提高成本效益（ICER为15，090英镑/QALY）。排除预防福利会降低成本效益。如果超过10%的被转介的PWID在监狱中接受治疗（2.5%的基础病例），任何一种治疗都可能具有很高的成本效益（ICER<13，000英镑）。如果DAA成本降低10%或持续8周，HCV病例发现和无IFN DAA可能具有高度成本效益。在英国监狱中增加HCV检测（例如通过选择退出检测）与目前治疗的20，000英镑WTP下的基于风险的自愿检测相比，具有边缘成本效益，但如果使用短期无IFN DAA，则可能具有成本效益，并且如果PWID治疗率增加，则可能具有高度成本效益。
Prisoners have a high prevalence of Hepatitis C virus (HCV), but case-finding may not have been cost-effective because treatment often exceeded average prison stay combined with a lack of continuity-of-care. We assess the cost-effectiveness of increased HCV case-finding and treatment in UK prisons using short-course therapies. A dynamic HCV transmission model assesses the cost-effectiveness of doubling HCV case-finding (achieved through introducing opt-out HCV testing in UK pilot prisons) and increasing treatment in UK prisons, compared to status-quo voluntary risk-based testing (6% prison entrants/year), using currently recommended therapies (8–24 weeks) or IFN-free DAAs (8–12 weeks, 95% SVR, £3300/wk). Costs (GBP£) and health utilities (quality-adjusted life-years, QALYs) were used to calculate mean incremental cost-effectiveness ratios (ICERs). We assume 56% referral and 2.5%/25% of referred people who inject drugs (PWID)/exPWID treated within 2 months of diagnosis in prison. PWID and ex/nonPWID are in prison an average 4/8 months, respectively. Doubling prison testing rates with existing treatments produces a mean ICER of £19,850/QALY gained compared to current testing/treatment, and is 45% likely to be cost-effective under a £20,000 willingness-to-pay (WTP) threshold. Switching to 8–12 week IFN-free DAAs in prisons could increase cost-effectiveness (ICER £15,090/QALY gained). Excluding prevention benefit decreases cost-effectiveness. If >10% referred PWID are treated in prison (2.5% base-case), either treatment could be highly cost-effective (ICER<£13,000). HCV case-finding and IFN-free DAAs could be highly cost-effective if DAA cost is 10% lower or 8 weeks duration. Increased HCV testing in UK prisons (such as through opt-out testing) is borderline cost-effective compared to status-quo voluntary risk-based testing under a £20,000 WTP with current treatments, but likely to be cost-effective if short-course IFN-free DAAs are used, and could be highly cost-effective if PWID treatment rates were increased.