Costs and cost-effectiveness of different follow-up schedules for detection of occupational hepatitis C virus infection
Costs and cost-effectiveness of different follow-up schedules for detection of occupational hepatitis C virus infection
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DOI：
10.1136/gut.2007.145516
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发表时间：
2009-01-01
期刊：
影响因子：
24.5
通讯作者：
Yazdanpanah, Y.
中科院分区：
文献类型：
--
作者：
Deuffic-Burban, S.;Abiteboul, D.;Yazdanpanah, Y.
目的：本研究的目的是比较早期丙型肝炎病毒（HCV）RNA检测的成本和成本-效果（C/E）（替代-美国建议）在职业暴露于HCV后，采用现有的随访策略：（1）第1、3和6个月的French、抗HCV抗体和丙氨酸转氨酶（ALT）活性;（2）欧洲人4个月内每月ALT活性和第6个月抗-HCV抗体;（3）美国基线、第6个月抗-HCV抗体和ALT活性。决策树模拟了法国每年7300名暴露于HCV的医护人员（HCW）的每种策略，考虑到早期诊断对抗病毒治疗的反应和暴露后HCW生活质量恶化的影响。对于暴露后0.5%的HCV传播风险，法国策略导致最高的费用/人（（原文如此）181.40），而基线-美国策略导致最低的费用/人（原文如此）126.60）（替代方案-美国为178.50）。采用替代-US策略获得的HCV感染诊断的平均时间最短（1个月）和慢性丙型肝炎（CHC）患者数量最少（1.9/7300 HCW暴露）（与基线-US分别为6个月和7.9 CHC）。与替代方案-美国相比，法国的战略与更高的成本和更低的公用事业，和欧洲与更高的增量C/E比。与基线相比，美国的战略，替代美国的战略C/E比（原文如此）2020每质量调整生命yearsaved.Conclusion：在HCWs暴露于HCV，基于早期HCV RNA检测的策略缩短了HCW的等待他的HCV状态的期间，导致进展为CHC的风险较低，是合理的成本效益。
Objective: The purpose of this study was to compare the costs and cost-effectiveness (C/E) of early hepatitis C virus (HCV) RNA testing (alternative-US recommendations) after occupational exposure to HCV with existing follow-up strategies: (1) French, anti-HCV antibodies and alanine transaminase (ALT) activity at months 1, 3 and 6; (2) European, monthly ALT activity for 4 months and anti-HCV antibodies at month 6; (3) and baseline-US, anti-HCV antibodies and ALT activity at month 6.Methods: A decision tree simulated each strategy for 7300 healthcare workers (HCWs) exposed to HCV each year in France, taking into account the impact of early diagnosis on the response to antiviral treatment and the deterioration of HCW quality of life after exposure.Results: For a HCV transmission risk of 0.5% after exposure, the French strategy led to the highest costs/person ((sic) 181.40) and the baseline-US strategy to the lowest ((sic) 126.60) ((sic) 178.50) for alternative-US). The shortest mean time to HCV infection diagnosis (1 month) and the lowest number of chronic hepatitis C (CHC) patients (1.9/7300 HCWs exposed) was obtained with the alternative-US strategy (vs 6 months and 7.9 CHC, respectively with baseline-US). Compared with the alternative-US, the French strategy was associated with higher costs and lower utilities, and the European with a higher incremental C/E ratio. Compared with the baseline-US strategy, the alternative-US strategy C/E ratio was (sic) 2020 per quality-adjusted life year saved.Conclusion: In HCWs exposed to HCV, a strategy based on early HCV RNA testing shortens the period during which the HCW's wait for his HCV status, leads to lower risk of progression to CHC and is reasonably cost-effective.