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Abstract：
People who inject drugs (PWID) are at high risk of hepatitis C virus (HCV) infection; however, ~50% are undiagnosed in England and linkage-to-care is poor. This study investigated the cost-effectiveness of an intervention (HepCATT) to improve case-finding and referral to HCV treatment compared with standard-of-care pathways in drug treatment centres in England.
HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5-fold and engagement onto the HCV treatment pathway 10-fold. A model was used to estimate the decrease in HCV infections and HCV-related deaths from 2016, with costs and health benefits (quality-adjusted life-years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken.
England-specific epidemic with 40% prevalence of chronic HCV among PWID.
PWID attending drug treatment centres.
Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case-finding to referral and linkage to specialist care. Comparator was the standard-of-care HCV care pathway.
Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained through improved case-finding.
Over 50 years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37-129) deaths and 1330 (827-2040) or 51% (30-67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost-effective at a £20 000 per QALY willingness-to-pay threshold. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33-70%) by 2030.
Increasing hepatitis C virus infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing hepatitis C virus incidence among people who inject drugs.
HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Primary outcome and cost data from the HepCATT study parameterized the intervention, suggesting that HepCATT increased HCV testing in drug treatment centres 2.5-fold and engagement onto the HCV treatment pathway 10-fold. A model was used to estimate the decrease in HCV infections and HCV-related deaths from 2016, with costs and health benefits (quality-adjusted life-years or QALYs) tracked over 50 years. Univariable and probabilistic sensitivity analyses (PSA) were undertaken.
England-specific epidemic with 40% prevalence of chronic HCV among PWID.
PWID attending drug treatment centres.
Nurse facilitator in drug treatment centres to improve the HCV care pathway from HCV case-finding to referral and linkage to specialist care. Comparator was the standard-of-care HCV care pathway.
Incremental cost-effectiveness ratio (ICER) in terms of cost per QALY gained through improved case-finding.
Over 50 years per 1000 PWID, the HepCATT intervention could prevent 75 (95% central interval 37-129) deaths and 1330 (827-2040) or 51% (30-67%) of all new infections. The mean ICER was £7986 per QALY gained, with all PSA simulations being cost-effective at a £20 000 per QALY willingness-to-pay threshold. Univariable sensitivity analyses suggest the intervention would become cost-saving if the cost of HCV treatment reduces to £3900. If scaled up to all PWID in England, the intervention would cost £8.8 million and decrease incidence by 56% (33-70%) by 2030.
Increasing hepatitis C virus infection case-finding and treatment referral in drug treatment centres could be a highly cost-effective strategy for decreasing hepatitis C virus incidence among people who inject drugs.
摘要：
注射药物（PWID）的人感染丙型肝炎病毒（HCV）的风险很高；然而，在英格兰，约有50％的人未被诊断出，并且与护理的联系很差。与英格兰药物治疗中心的标准护理途径相比，这项研究调查了干预措施（HepCATT）的成本效益，以改善病例发现和转诊HCV治疗。
使用医疗保健观点进行成本效益分析的HCV传播和疾病进展模型。来自HepCATT研究的主要结果和成本数据参数化了干预措施，提示HepCATT使药物治疗中心的HCV检测增加了2.5倍,参与HCV治疗途径增加了10倍.使用一个模型来估计2016年HCV感染和HCV相关死亡的减少，成本和健康益处（质量调整生命年或QALYs）追踪超过50年。进行了单变量和概率敏感性分析（PSA）。
英国特有的流行病，在PWID中有40%的慢性HCV患病率。
PWID参加药物治疗中心。
药物治疗中心的护士促进者，以改善从HCV病例发现到转诊以及与专科护理的联系的HCV护理途径。比较物是标准的护理HCV护理途径。
增量成本效益比(ICER)，即通过改进病例发现获得的每个QALY成本。
每1000个PWID超过50年，HepCATT干预可预防75例(95%中枢间期37-129)死亡和1330例(827-2040)或51%(30-67%)的所有新感染.平均ICER为每QALY获得7986英镑，所有PSA模拟都具有成本效益，每QALY支付意愿门槛为20,000英镑。单变量敏感性分析表明，如果HCV治疗的成本降低到3900英镑，干预措施将节省成本。如果扩大到英格兰的所有PWID，这项干预措施将耗资880万英镑，到2030年将发病率降低56%(33-70%)。
在药物治疗中心增加丙型肝炎病毒感染病例发现和治疗转诊可能是降低注射毒品人群丙型肝炎病毒发病率的高成本效益策略。
使用医疗保健观点进行成本效益分析的HCV传播和疾病进展模型。来自HepCATT研究的主要结果和成本数据参数化了干预措施，提示HepCATT使药物治疗中心的HCV检测增加了2.5倍,参与HCV治疗途径增加了10倍.使用一个模型来估计2016年HCV感染和HCV相关死亡的减少，成本和健康益处（质量调整生命年或QALYs）追踪超过50年。进行了单变量和概率敏感性分析（PSA）。
英国特有的流行病，在PWID中有40%的慢性HCV患病率。
PWID参加药物治疗中心。
药物治疗中心的护士促进者，以改善从HCV病例发现到转诊以及与专科护理的联系的HCV护理途径。比较物是标准的护理HCV护理途径。
增量成本效益比(ICER)，即通过改进病例发现获得的每个QALY成本。
每1000个PWID超过50年，HepCATT干预可预防75例(95%中枢间期37-129)死亡和1330例(827-2040)或51%(30-67%)的所有新感染.平均ICER为每QALY获得7986英镑，所有PSA模拟都具有成本效益，每QALY支付意愿门槛为20,000英镑。单变量敏感性分析表明，如果HCV治疗的成本降低到3900英镑，干预措施将节省成本。如果扩大到英格兰的所有PWID，这项干预措施将耗资880万英镑，到2030年将发病率降低56%(33-70%)。
在药物治疗中心增加丙型肝炎病毒感染病例发现和治疗转诊可能是降低注射毒品人群丙型肝炎病毒发病率的高成本效益策略。
