Título
Cost-effectiveness analysis of different testing strategies that use antibody levels to detect chronic hepatitis C in blood donors
Autor
VICTOR GRANADOS GARCIA
ANA MARIA BERTHA CONTRERAS NAVARRO
María del Carmen García Peña
GUILLERMO SALINAS ESCUDERO
Hla_Hla Thein
MELVA YVONNE FLORES DUEÑAS
Nivel de Acceso
Acceso Abierto
Materias
BIOLOGÍA Y QUÍMICA - (CTI) Ciencias de la vida - ([Plos One (1932-6203) vol. 11 (2016)]) Virología - ([Plos One (1932-6203) vol. 11 (2016)]) Virus - ([Plos One (1932-6203) vol. 11 (2016)]) Enfermedades del sistema digestivo - ([Plos One (1932-6203) vol. 11 (2016)]) Enfermedades del hígado - ([Plos One (1932-6203) vol. 11 (2016)]) Hepatitis viral humana - ([Plos One (1932-6203) vol. 11 (2016)]) Hepatitis C crónica (diagnóstico) - ([Plos One (1932-6203) vol. 11 (2016)]) Aminoácidos, péptidos y proteínas - ([Plos One (1932-6203) vol. 11 (2016)]) Proteínas sanguíneas - ([Plos One (1932-6203) vol. 11 (2016)]) Inmunoproteínas - ([Plos One (1932-6203) vol. 11 (2016)]) Inmunoglobinas - ([Plos One (1932-6203) vol. 11 (2016)]) Anticuerpos virales - ([Plos One (1932-6203) vol. 11 (2016)]) Anticuerpos de hepatitis - ([Plos One (1932-6203) vol. 11 (2016)]) Digestive system diseases - ([Plos One (1932-6203) vol. 11 (2016)]) Liber diseases - ([Plos One (1932-6203) vol. 11 (2016)]) Hepatitis, viral, human - ([Plos One (1932-6203) vol. 11 (2016)]) Hepatitis C, chronic (diagnostic) - ([Plos One (1932-6203) vol. 11 (2016)]) Amino acids, peptides and proteins - ([Plos One (1932-6203) vol. 11 (2016)]) Blood proteins - ([Plos One (1932-6203) vol. 11 (2016)]) Immunoproteins - ([Plos One (1932-6203) vol. 11 (2016)]) immunoglobines - ([Plos One (1932-6203) vol. 11 (2016)]) Antibodies, viral - ([Plos One (1932-6203) vol. 11 (2016)]) Hepatitis antibodies - ([Plos One (1932-6203) vol. 11 (2016)])
Resumen o descripción
Abstract: Aim. We conducted a cost-effectiveness analysis of seven hepatitis C virus (HCV) testing strategies in blood donors. Methods. Three of the seven strategies were based on HCV diagnosis and reporting guidelines in Mexico and four were from previous and current recommendations outlined by the CDC. The strategies that were evaluated determine antibody levels according to the signal-to-cut-off (S/CO) ratio and use reflex Immunoblot (IMB) or HCV RNA tests to confirm true positive (TP) cases of chronic HCV infection. Costs were calculated from the perspective of the Mexican Institute of Social Security (IMSS). A decision tree model was developed to estimate the expected number of true positive cases and costs for the base-case scenarios and for the sensitivity analyses. Results. Base-case findings indicate an extended dominance of the CDC-USA2 and CDC-USA4 options by the IMSS Mexico3 and IMSS-Mexico1 alternatives. The probabilistic sensitivity analyses results suggest that for a willingness-to-pay (WTP) range of $0–9,000 USD the IMSS-Mexico1 strategy is the most cost-effective of all strategies ($5,000 USD per TP). The IMSS-Mexico3, IMSS-Mexico2, and CDC-USA3 strategies are also cost-effective strategies that cost between $7,800 and $8,800 USD per TP case detected. The CDC-USA1 strategy was very expensive and not cost-effective. Conclusions. HCV antibody testing strategies based on the classification of two or three levels of the S/CO are cost-effective procedures to identify patients who require reflex IMB or HCV RNA testing to confirm chronic HCV infection.
Conclusion: Finding ways to improve the policies and procedures to confirm a chronic infection in patients with a positive Anti-HCV result is critical. Under the current risk-based screening practices, approximately two-thirds of patients will remain undiagnosed until they progress to severe hepatic cirrhosis or liver-related death [3]. Based on the results of our study, our policy recommendations for the diagnosis of chronic HCV infections would be to classify antibodies in two or three levels as measured by the S/CO ratio, and to use the follow-up procedures recommended by the IMSS-Mexico3, IMSS-Mexico2, or CDC-USA3 strategies.
In high-income countries, the main risk factor for HCV is injection drug use. In low-and middle-income countries, the most important risk factors for the nosocomial transmission of HCV are unsafe practices and medical procedures, mainly due to reusing syringes for dispensing intravenous solutions and/or drugs [21, 22]. Although the risk factors for HCV infection are different in low, middle and high-income countries, there is evidence that current diagnosis practices may limit the ability to diagnose chronic HCV patients [23, 24]. Our conclusion is that HCV antibody testing strategies should be based on a classification of two or three antibody levels of the S/CO because they are the most cost-effective way to identify patients who require supplementary testing such as IMB or HCV RNA to confirm a chronic HCV infection.
Editor
Public Library of Science
Fecha de publicación
2016
Tipo de publicación
Artículo
Recurso de información
Formato
Adobe PDF
application/pdf
Fuente
Plos One (1932-6203) vol. 11 (2016)
Idioma
Inglés
Relación
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0154625
Repositorio Orígen
INSTITUTO NACIONAL DE GERIATRIA
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