我国消除丙型肝炎的普通人群HCV检测策略的成本效果分析

刘鹏程; 徐迪; 丁国伟; 赵靓; 虞接军; 刘中夫; 李健

Abstract

刘鹏程,徐迪,丁国伟,赵靓,虞接军,刘中夫,李健.我国消除丙型肝炎的普通人群HCV检测策略的成本效果分析[J].Chinese journal of Epidemiology,2024,45(3):464-472

我国消除丙型肝炎的普通人群HCV检测策略的成本效果分析

Cost-effectiveness of HCV testing strategies for hepatitis C elimination in general population in China

Received:September 08, 2023

DOI：10.3760/cma.j.cn112338-20230908-00140

KeyWord: 丙型肝炎普通人群检测成本效果马尔科夫模型

English Key Word: Hepatitis C General population Screening Cost-effectiveness Markov model

FundProject:丙肝防治技术指导与能力建设项目（131031105000200002）

Author Name	Affiliation	E-mail
Liu Pengcheng	National Center for STD/AIDS Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Xu Di	Shanghai Municipal Center for Disease Control and Prevention, Shanghai 200336, China
Ding Guowei	National Center for STD/AIDS Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Zhao Liang	National Center for STD/AIDS Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Yu Jiejun	National Center for STD/AIDS Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Liu Zhongfu	National Center for STD/AIDS Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Li Jian	National Center for STD/AIDS Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China	jli@chinaaids.cn

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Abstract:

目的分析我国消除丙型肝炎（丙肝）的普通人群HCV检测策略的成本效果，明确最佳成本效果的HCV检测年龄。方法运用TreeAge pro 2019软件构建决策树马尔科夫模型，以1年为周期，模拟10万名20~59岁各年龄组人群HCV检测和治疗结果，以全社会角度分析策略间比较的成本效果和效益。效果指标为增量成本效果比（ICER），效益指标为净货币效益（NMB），以我国2022年人均国内生产总值（85 698元）为意愿支付阈值。通过单因素敏感性分析和概率敏感性分析评估结果可靠性。结果在20~59岁人群HCV检测有成本效果，在40~49岁年龄组进行HCV检测成本效果最佳。20~59岁年龄组人群HCV检测策略与未HCV检测策略比较，增量成本为161.24元/人，增量效用为0.003 6质量调整寿命年（QALYs）/人，ICER为45 197.26元/QALY，ICER小于意愿支付阈值，具有成本效果。各年龄组人群HCV检测策略与未HCV检测策略比较，ICER为42 055.06~53 249.43元/QALY，NMB为96.52~169.86元/人，其中40~49岁年龄组的ICER最低，NMB最高。单因素敏感性分析结果显示，贴现率、丙肝抗体（抗-HCV）检测成本、人群抗-HCV阳性率和直接抗病毒药物治疗成本对经济学评价影响较大，但改变参数取值，结论不变。概率敏感性分析结果表明模型分析结果稳定。结论医疗机构探索动员20~59岁普通人群进行HCV检测具有较好的成本效果，以40~49岁年龄组人群的HCV检测成本效果最佳。在我国普通人群中实施HCV检测的“愿检尽检”策略，能降低人群丙肝疾病负担。

English Abstract:

Objective To evaluate the cost-effectiveness of hepatitis C screening in general population in China, and find the age group in which hepatitis C screening can achieve the best cost-effectiveness. Methods A decision-Markov model was constructed by using software TreeAge pro 2019 to simulate the outcomes of hepatitis C disease pregression of 100 000 persons aged 20-59 years. The cost-effectiveness of the strategies were evaluated from societal perspectives by using incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). One-way sensitivity analysis and probability sensitivity analysis were used to evaluate the uncertainty of parameters and model. Results Hepatitis C screening was cost-effective in people aged 20- 59 years and the cost effectiveness was best in age group 40-49 years. Compared with non-screening strategy of hepatitis C in people aged 20-59 years, the incremental cost was 161.24 yuan, the incremental utility was 0.003 6 quality adjusted life years (QALYs)/per person, ICER was 45 197.26 yuan/QALY, ICER was less than the willing payment threshold. The ICER and NMB in all age groups were 42 055.06-53 249.43 yuan/QALY and 96.52-169.86 yuan/per person. Hepatitis C screening in people aged 40-49 years had the best cost-effectiveness. The results of one-way sensitivity analysis showed that the discount rate, anti-HCV detection cost, anti-HCV infection rate and the cost of direct antiviral agents were the main factors influencing economic evaluation. The results of the probability sensitivity analysis indicated that the model analysis was stable. Conclusions Implementing hepatitis C screening based on medical institutions is cost-effective in people aged 20- 59 years, especially in those aged 40-49 years. Implementing the HCV screening strategy of be willing to test as far as possible in general population can reduce hepatitis C disease burden in China.

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