1. An Economic Evaluation of the Cost-Effectiveness of Opt-Out Hepatitis B and Hepatitis C Testing in an Emergency Department Setting in the United Kingdom.
- Author
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Williams, Jack, Vickerman, Peter, Douthwaite, Sam, Nebbia, Gaia, Hunter, Laura, Wong, Terry, Ruf, Murad, and Miners, Alec
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HEPATITIS B , *HEPATITIS C , *HOSPITAL emergency services , *SERODIAGNOSIS , *AGRICULTURE costs , *COST effectiveness , *VIRAL hepatitis , *EMERGENCY medical services communication systems , *HEPATITIS C diagnosis , *RESEARCH , *RESEARCH methodology , *MEDICAL screening , *HOSPITAL costs , *EVALUATION research , *MEDICAL cooperation , *COMPARATIVE studies , *STATISTICAL models , *PROBABILITY theory - Abstract
Objectives: The prevalence of hepatitis is high in emergency department (ED) attendees in the United Kingdom, with a prevalence of up to 2% for hepatitis B (HBV) HBsAg, and 2.9% for hepatitis C (HCV) RNA. The aim of this paper is to perform an economic evaluation of opt-out ED-based HCV and HBV testing.Methods: A Markov model was developed to analyze the cost-effectiveness of opt-out HCV and HBV testing in EDs in the UK. The model used data from UK studies of ED testing to parameterize the HCV and HBV prevalence (1.4% HCV RNA, 0.84% HBsAg), test costs, and intervention effects (contact rates and linkage to care). For HCV, we used an antibody test cost of £3.64 and RNA test cost of £68.38, and assumed direct-acting antiviral treatment costs of £10 000. For HBV, we used a combined HBsAg and confirmatory test cost of £5.79. We also modeled the minimum prevalence of HCV (RNA-positive) and HBV (HBsAg) required to make ED testing cost-effective at a £20 000 willingness to pay per quality-adjusted life-year threshold.Results: In the base case, ED testing was highly cost-effective, with HCV and HBV testing costing £8019 and £9858 per quality-adjusted life-year gained, respectively. HCV and HBV ED testing remained cost-effective at 0.25% HCV RNA or HBsAg prevalence or higher.Conclusions: Emergency department testing for HCV and HBV is highly likely to be cost-effective in many areas across the UK depending on their prevalence. Ongoing studies will help evaluate ED testing across different regions to inform testing guidelines. [ABSTRACT FROM AUTHOR]- Published
- 2020
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