Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis.
PLoS One
; 14(7): e0219687, 2019.
Article
em En
| MEDLINE
| ID: mdl-31310636
ABSTRACT
OBJECTIVE:
Screening for hepatitis C in Russia is a complex process that involves several visits and stepwise testing, limiting adherence and substantially reducing the yield in the identification of active infections. We aimed to evaluate the cost-effectiveness of different screening algorithms from a health system perspective.METHODS:
A decision analytic model was applied to a hypothetical adult population eligible to participate in a general screening program for hepatitis C in Russia. The standard pathway (I Screen for anti-HCV antibodies followed by a nucleic acid test for HCV RNA on antibody positives) was compared to three alternatives (II Screen for antibodies, a reflexed test for HCV antigen on antibody positives, and RNA on antigen negatives; III Screen for antibodies, a reflexed test for HCV antigen on antibody positives; IV Screen for antigen). Each strategy considered a cascade of events (referral, adherence, testing, diagnosis) that must occur for screening to be effective. The primary measure of effectiveness was the number of diagnosed active infections. Calculations followed a health system perspective with costs derived from 2017 reimbursement rates and a willingness-to-pay of 2,000RUB ($82) per diagnosed active infection. Model was tested with deterministic and probabilistic sensitivity analyses.RESULTS:
Non-adherence to screening stages reduced the capture rate of active infections in Strategy I from 79.0% to 40.6%. Strategies II, III, and IV were less affected and identified 69%, 67%, and 104% more infections. Average costs per diagnosed infection were decreased by 41% from 89,599RUB ($3,681) for I to 53,072RUB ($2,180), 53,004RUB ($2,177), and 59,633RUB ($2,450) for II, III, and IV, respectively. With a probability of 97%, Strategy III was most cost-effective with an incremental cost-effectiveness ratio vs. I of -1,373RUB (CI -5,011RUB to -2,033RUB; $-56; CI -$206 to -$84). Below a willingness-to-pay of 91,000RUB ($3,738), Strategy IV was not cost-effective. Sensitivity analyses confirmed the robustness of results.CONCLUSIONS:
Testing strategies for hepatitis C with HCV antigen on HCV antibody positive cases offer a streamlining opportunity for population screening programs. Those shall increase the chances for detecting active infections and are cost-effective over current practice in Russia.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Programas de Rastreamento
/
Análise Custo-Benefício
/
Hepatite C
/
Hepacivirus
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article