Cost-Effectiveness Analysis of Screening for Persistent Hepatitis E Virus Infection in Solid Organ Transplant Patients in the United Kingdom: A Model-Based Economic Evaluation.
| Title: | Cost-Effectiveness Analysis of Screening for Persistent Hepatitis E Virus Infection in Solid Organ Transplant Patients in the United Kingdom: A Model-Based Economic Evaluation. |
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| Authors: | Ankcorn MJ; Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, Colindale, London, England, UK; Transfusion Microbiology, National Health Service Blood and Transplant, London, England, UK. Electronic address: michaelankcorn@nhs.net.; Tedder RS; Blood Borne Virus Unit, Virus Reference Department, National Infection Service, Public Health England, Colindale, London, England, UK; Transfusion Microbiology, National Health Service Blood and Transplant, London, England, UK; Department of Medicine, Imperial College London, London, England, UK.; Cairns J; London School of Hygiene and Tropical Medicine, London, England, UK.; Sandmann FG; London School of Hygiene and Tropical Medicine, London, England, UK; Statistics, Modelling and Economics Department, National Infection Service, Public Health England, Colindale, London, England, UK. |
| Source: | Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research [Value Health] 2020 Mar; Vol. 23 (3), pp. 309-318. Date of Electronic Publication: 2019 Nov 15. |
| Publication Type: | Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | Publisher: Elsevier Country of Publication: United States NLM ID: 100883818 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4733 (Electronic) Linking ISSN: 10983015 NLM ISO Abbreviation: Value Health Subsets: MEDLINE |
| Imprint Name(s): | Publication: Jan./Feb. 2011- : New York : Elsevier; Original Publication: Malden, MA : Blackwell Science, c1998- |
| MeSH Terms: | Health Care Costs*; Hepatitis E/*diagnosis ; Hepatitis E/*economics ; Mass Screening/*economics ; Organ Transplantation/*economics ; State Medicine/*economics; Clinical Enzyme Tests/economics ; Hepatitis E/mortality ; Organ Transplantation/adverse effects ; Organ Transplantation/mortality ; Polymerase Chain Reaction/economics ; Serologic Tests/economics ; United Kingdom/epidemiology ; Cost Savings ; Cost-Benefit Analysis ; Humans ; Markov Chains ; Models, Economic ; Predictive Value of Tests ; Prevalence ; Quality-Adjusted Life Years ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome |
| Abstract: | Background: Despite potentially severe and fatal outcomes, recent studies of solid organ transplant (SOT) recipients in Europe suggest that hepatitis E virus (HEV) infection is underdiagnosed, with a prevalence of active infection of up to 4.4%.; Objectives: To determine the cost-effectiveness of introducing routine screening for HEV infection in SOT recipients in the UK.; Methods: A Markov cohort model was developed to evaluate the cost-utility of 4 HEV screening options over the lifetime of 1000 SOT recipients. The current baseline of nonsystematic testing was compared with annual screening of all patients by polymerase chain reaction (PCR; strategy A) or HEV-antigen (HEV-Ag) detection (strategy B) and selective screening of patients who have a raised alanine aminotransferase (ALT) value by PCR (strategy C) or HEV-Ag (strategy D). The primary outcome was the incremental cost per quality-adjusted life-year (QALY). We adopted the National Health Service (NHS) perspective and discounted future costs and benefits at 3.5%.; Results: At a willingness-to-pay of £20 000/QALY gained, systematic screening of SOT patients by any method (strategy A-D) had a high probability (77.9%) of being cost-effective. Among screening strategies, strategy D is optimal and expected to be cost-saving to the NHS; if only PCR testing strategies are considered, then strategy C becomes cost-effective (£660/QALY). These findings were robust against a wide range of sensitivity and scenario analyses.; Conclusions: Our model showed that routine screening for HEV in SOT patients is very likely to be cost-effective in the UK, particularly in patients presenting with an abnormal alanine aminotransferase.; (Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.) |
| Contributed Indexing: | Keywords: cost-effectiveness; hepatitis E virus; screening; solid organ transplantation |
| Entry Date(s): | Date Created: 20200322 Date Completed: 20200727 Latest Revision: 20200727 |
| Update Code: | 20260130 |
| DOI: | 10.1016/j.jval.2019.09.2751 |
| PMID: | 32197726 |
| Database: | MEDLINE |
Comparative Study; Journal Article; Research Support, Non-U.S. Gov't