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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. | LitMetric

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.

Value Health

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.

Published: March 2020

AI Article Synopsis

  • Recent studies indicate that hepatitis E virus (HEV) infection is underdiagnosed among solid organ transplant (SOT) recipients in Europe, with an active infection prevalence reaching 4.4%.
  • The study aims to evaluate the cost-effectiveness of routine HEV screening for SOT recipients in the UK using a Markov cohort model that compares various screening strategies.
  • Results suggest that systematic screening for HEV is likely cost-effective, especially for patients with elevated ALT levels, with one strategy expected to be cost-saving for the NHS.

Article 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.

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Source
http://dx.doi.org/10.1016/j.jval.2019.09.2751DOI Listing

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