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Assessing the potential cost-effectiveness of centralised versus point-of-care testing for hepatitis C virus in Pakistan: a model-based comparison.

التفاصيل البيبلوغرافية
العنوان: Assessing the potential cost-effectiveness of centralised versus point-of-care testing for hepatitis C virus in Pakistan: a model-based comparison.
المؤلفون: Babigumira JB; Saw Swee Hock School of Public Health, National University of Singapore, Singapore., Karichu JK; Roche Molecular Systems Inc, Pleasanton, California, USA james.karichu@roche.com., Clark S; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington Seattle Campus, Seattle, Washington, USA., Cheng MM; Roche Molecular Systems Inc, Pleasanton, California, USA., Garrison LP; The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington Seattle Campus, Seattle, Washington, USA.; VeriTech Corporation, Mercer Island, Washington, USA., Maniecki MB; Roche Molecular Systems Inc, Pleasanton, California, USA., Hamid SS; The Aga Khan University, Karachi, Pakistan.
المصدر: BMJ open [BMJ Open] 2023 May 04; Vol. 13 (5), pp. e066770. Date of Electronic Publication: 2023 May 04.
نوع المنشور: Journal Article; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [London] : BMJ Publishing Group Ltd, 2011-
مواضيع طبية MeSH: Hepacivirus* , Hepatitis C*/diagnosis , Hepatitis C*/epidemiology, Humans ; Cost-Benefit Analysis ; Pakistan/epidemiology ; Point-of-Care Testing ; Mass Screening
مستخلص: Objectives: Pakistan has a hepatitis C virus (HCV) infection prevalence of 6%-9% and aims to achieve World Health Organisation (WHO) targets for elimination of HCV by the year 2030. We aim to evaluate the potential cost-effectiveness of a reference laboratory-based (centralised laboratory testing; CEN) confirmatory testing approach versus a molecular near-patient point-of-care (POC) confirmatory approach to screen the general population for HCV in Pakistan.
Study Design: We used a decision tree-analytic model from a governmental (formal healthcare sector) perspective.
Study Setting: Individuals were assumed to be initially screened with an anti-HCV test at home, followed by POC nucleic acid test (NAT) at nearby district hospitals or followed by NAT at centralised laboratories.
Participants: We included the general testing population for chronic HCV in Pakistan.
Intervention: Screening with an anti-HCV antibody test (Anti-HCV) followed by either POC NAT (Anti-HCV-POC), or reference laboratory NAT (Anti-HCV-CEN), was compared, using data from published literature and the Pakistan Ministry of Health.
Measures: Outcome measures included: number of HCV infections identified per year, percentage of individuals correctly classified, total costs, average costs per individual tested, and cost-effectiveness (assessed as cost per additional HCV infection identified). Sensitivity analysis was also performed.
Results: At a national level (25 million annual screening tests), the Anti-HCV-CEN strategy would identify 142 406 more HCV infections in 1 year and increase correct classification of individuals by 0.57% compared with the Anti-HCV-POC strategy. The total annual cost of HCV testing was reduced using the Anti-HCV-CEN strategy by US$7.68 million (US$0.31/person). Thus, incrementally, the Anti-HCV-CEN strategy costs less and identifies more HCV infections than Anti-HCV-POC. The incremental difference in HCV infections identified was most sensitive to the probability of loss to follow-up (for POC confirmatory NAT).
Conclusions: Anti-HCV-CEN would provide the best value for money when scaling up HCV testing in Pakistan.
Competing Interests: Competing interests: JBB and SC served as paid consultants to Roche Molecular Systems, Inc. JKK is an employee of Roche Diagnostics Solutions. MBM is an employee of Roche Molecular Systems, Inc. MMC was an employee of Roche Molecular Systems, Inc. at the time this study was conducted and remains a stockholder. LPG served as a paid consultant to Roche Molecular Systems, Inc. and received grants or has contracts with Gilead Sciences. SSH has no conflicts of interest to declare. COBAS is a trademark of Roche. All other product names and trademarks are the property of their respective owners.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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فهرسة مساهمة: Keywords: health economics; hepatology; public health
تواريخ الأحداث: Date Created: 20230504 Date Completed: 20230508 Latest Revision: 20230512
رمز التحديث: 20231215
مُعرف محوري في PubMed: PMC10163545
DOI: 10.1136/bmjopen-2022-066770
PMID: 37142306
قاعدة البيانات: MEDLINE
الوصف
تدمد:2044-6055
DOI:10.1136/bmjopen-2022-066770