Cost-Effectiveness of One-Time Hepatitis C Screening Strategies Among Adolescents and Young Adults in Primary Care Settings
| Autor: | Peter C. Smith, Mari-Lynn Drainoni, Bruce R. Schackman, C. Robert Horsburgh, Craig Regis, Sabrina A. Assoumou, Jared A. Leff, Benjamin P. Linas, Abriana Tasillo, Arthur Y. Kim, M. Anita Barry, Alison Marshall, Sheel Saxena |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Diagnostic Screening Programs Male Microbiology (medical) medicine.medical_specialty Adolescent Routine testing Cost effectiveness Cost-Benefit Analysis Hepacivirus Primary care Young Adult 03 medical and health sciences 0302 clinical medicine Urban Health Services Humans Medicine Computer Simulation 030212 general & internal medicine Young adult Substance Abuse Intravenous health care economics and organizations Venipuncture Primary Health Care business.industry Analytic model Hepatitis C Chronic Infectious Diseases Hepatitis C screening Emergency medicine Quality of Life Female 030211 gastroenterology & hepatology Lower cost Quality-Adjusted Life Years business |
| Zdroj: | Clinical Infectious Diseases. 66:376-384 |
| ISSN: | 1537-6591 1058-4838 |
| DOI: | 10.1093/cid/cix798 |
| Popis: | High hepatitis C virus (HCV) rates have been reported in young people who inject drugs (PWID). We evaluated the clinical benefit and cost-effectiveness of testing among youth seen in communities with a high overall number of reported HCV cases.We developed a decision analytic model to project quality-adjusted life years (QALYs), costs (2016 US$), and incremental cost-effectiveness ratios (ICERs) of 9 strategies for 1-time testing among 15- to 30-year-olds seen at urban community health centers. Strategies differed in 3 ways: targeted vs routine testing, rapid finger stick vs standard venipuncture, and ordered by physician vs by counselor/tester using standing orders. We performed deterministic and probabilistic sensitivity analyses (PSA) to evaluate uncertainty.Compared to targeted risk-based testing (current standard of care), routine testing increased the lifetime medical cost by $80 and discounted QALYs by 0.0013 per person. Across all strategies, rapid testing provided higher QALYs at a lower cost per QALY gained and was always preferred. Counselor-initiated routine rapid testing was associated with an ICER of $71000/QALY gained. Results were sensitive to offer and result receipt rates. Counselor-initiated routine rapid testing was cost-effective (ICER$100000/QALY) unless the prevalence of PWID was0.59%, HCV prevalence among PWID was16%, reinfection rate was26 cases per 100 person-years, or reflex confirmatory testing followed all reactive venipuncture diagnostics. In PSA, routine rapid testing was the optimal strategy in 90% of simulations.Routine rapid HCV testing among 15- to 30-year-olds may be cost-effective when the prevalence of PWID is0.59%. |
| Databáze: | OpenAIRE |
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