Search

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]

Background Poor mental health is the largest single source of disability in the UK, and co-morbid health problems, particularly with cancer, raise total health care costs significantly. Methods This study examined what research is being conducted into the intersection between cancer and mental health. Research papers captured by the intersection of sub-field filters—‘mental disorder’ and ‘cancer’—were studied from the Web of Science over a 10-year period (2002–2011). Results There were 1463 papers dealing with the dual presence of cancer and mental disorder. They amounted to 0.26% of cancer research and 0.51% of mental health research over the 10-year period, indicating that their intersection receives little research attention. Eighty per cent of papers were concerned with the effects of cancer on mental health rather than the reverse; a few (5%) looked at the post-traumatic stress suffered by carers of cancer patients. Of cancer types, breast dominated (21%), followed by prostate (5%), lung (3%), oral (2%) and colorectal (2%) cancer. The area of mental health most studied in cancer was unipolar depression. Conclusions The paucity of research that exists at the intersection of cancer and mental health requires attention from policymakers and funders in order to address an important trans-disciplinary gap in health care research. [ABSTRACT FROM PUBLISHER]