Cost-Effectiveness Analysis of Screening for Persistent Hepatitis E Virus Infection in Solid Organ Transplant Patients in the United Kingdom: A Model-Based Economic Evaluation.
Value Health
; 23(3): 309-318, 2020 03.
Article
em En
| MEDLINE
| ID: mdl-32197726
ABSTRACT
BACKGROUND:
Despite potentially severe and fatal outcomes, recent studies of solid organ transplant (SOT) recipients in Europe suggest that hepatitis E virus (HEV) infection is underdiagnosed, with a prevalence of active infection of up to 4.4%.OBJECTIVES:
To determine the cost-effectiveness of introducing routine screening for HEV infection in SOT recipients in the UK.METHODS:
A Markov cohort model was developed to evaluate the cost-utility of 4 HEV screening options over the lifetime of 1000 SOT recipients. The current baseline of nonsystematic testing was compared with annual screening of all patients by polymerase chain reaction (PCR; strategy A) or HEV-antigen (HEV-Ag) detection (strategy B) and selective screening of patients who have a raised alanine aminotransferase (ALT) value by PCR (strategy C) or HEV-Ag (strategy D). The primary outcome was the incremental cost per quality-adjusted life-year (QALY). We adopted the National Health Service (NHS) perspective and discounted future costs and benefits at 3.5%.RESULTS:
At a willingness-to-pay of £20 000/QALY gained, systematic screening of SOT patients by any method (strategy A-D) had a high probability (77.9%) of being cost-effective. Among screening strategies, strategy D is optimal and expected to be cost-saving to the NHS; if only PCR testing strategies are considered, then strategy C becomes cost-effective (£660/QALY). These findings were robust against a wide range of sensitivity and scenario analyses.CONCLUSIONS:
Our model showed that routine screening for HEV in SOT patients is very likely to be cost-effective in the UK, particularly in patients presenting with an abnormal alanine aminotransferase.Palavras-chave
Texto completo:
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Temas:
ECOS
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Aspectos_gerais
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Avaliacao_economica
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Financiamentos_gastos
Bases de dados:
MEDLINE
Assunto principal:
Medicina Estatal
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Programas de Rastreamento
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Transplante de Órgãos
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Hepatite E
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Custos de Cuidados de Saúde
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Health_economic_evaluation
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Aspecto:
Patient_preference
Limite:
Humans
País/Região como assunto:
Europa
Idioma:
En
Revista:
Value Health
Assunto da revista:
FARMACOLOGIA
Ano de publicação:
2020
Tipo de documento:
Article