英国布里斯托大学Matthew Hickman小组，分析了提高丙型肝炎病毒检测和治疗的干预措施的成本效果。该项研究成果发表在2020年2月26日出版的《英国医学杂志》上。

为了评估一项复杂的旨在增加丙型肝炎病毒（HCV）病例检出和减少治疗的初级保健干预措施的有效性和成本效益，研究组设计了一项务实、双臂、实践级别的分组随机对照试验，并进行经济评估。

研究组共招募了24473名参与者，其中13097名接受干预实践，对具有HCV风险的患者进行标记，进行HCV相关培训提高患者意识，并邀请患者进行HCV检测，持续一年；余下11376名为对照组。

在研究开始前的6个月，干预组有4.6%的患者接受了基线HCV检测，对照组有3.3%。在研究期间，干预组中有16%的患者进行了HCV检测，对照组中有10%，差异显著。干预组接受检测的患者中有6.2%HCV抗体阳性，对照组有4.4%。

干预组额外诊断、转诊和评估的发生率显著高于对照组。识别每个高风险病例的平均费用为4.03英镑，每增加一名患者接受肝病评估，则需支付3165英镑。每质量调整生命年（QALY）的成本效益增量比为6212英镑，92.5%低于20000英镑。

总之，增加HCV检测和治疗的干预措施影响不大，但成本很低，值得优化与实施。

附：英文原文

Title: Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT): cluster randomised controlled trial in primary care

Author: Kirsty Roberts, John Macleod, Chris Metcalfe, Will Hollingworth, Jack Williams, Peter Muir, Peter Vickerman, Clare Clement, Fiona Gordon, Will Irving, Cherry-Ann Waldron, Paul North, Philippa Moore, Ruth Simmons, Alec Miners, Jeremy Horwood, Matthew Hickman

Issue&Volume: 2020/02/26

Abstract: AbstractObjective To evaluate the effectiveness and cost effectiveness of a complex intervention in primary care that aims to increase uptake of hepatitis C virus (HCV) case finding and treatment.Design Pragmatic, two armed, practice level, cluster randomised controlled trial and economic evaluation.Setting and participants 45 general practices in South West England (22 randomised to intervention and 23 to control arm). Outcome data were collected from all intervention practices and 21/23 control practices. Total number of flagged patients was 24473 (about 5% of practice list).Intervention Electronic algorithm and flag on practice systems identifying patients with HCV risk markers (such as history of opioid dependence or HCV tests with no evidence of referral to hepatology), staff educational training in HCV, and practice posters/leaflets to increase patients’ awareness. Flagged patients were invited by letter for an HCV test (with one follow-up) and had on-screen pop-ups to encourage opportunistic testing. The intervention lasted one year, with practices recruited April to December 2016.Main outcome measures Primary outcome: uptake of HCV testing. Secondary outcomes: number of positive HCV tests and yield (proportion HCV positive); HCV treatment assessment at hepatology; cost effectiveness.Results Baseline HCV testing of flagged patients (six months before study start) was 608/13097 (4.6%) in intervention practices and 380/11376 (3.3%) in control practices. During the study 2071 (16%) of flagged patients in the intervention practices and 1163 (10%) in control practices were tested for HCV: overall intervention effect as an adjusted rate ratio of 1.59 (95% confidence interval 1.21 to 2.08; P<0.001). HCV antibodies were detected in 129 patients from intervention practices and 51 patients from control practices (adjusted rate ratio 2.24, 1.47 to 3.42) with weak evidence of an increase in yield (6.2% v 4.4%; adjusted risk ratio 1.40, 0.99 to 1.95). Referral and assessment increased in intervention practices compared with control practices (adjusted rate ratio 5.78, 1.6 to 21.6) with a risk difference of 1.3 per 1000 and a “number needed to help” of one extra HCV diagnosis, referral, and assessment per 792 (95% confidence interval 558 to 1883) patients flagged. The average cost of HCV case finding was ￡4.03 (95% confidence interval ￡2.27 to ￡5.80) per at risk patient and ￡3165 per additional patient assessed at hepatology. The incremental cost effectiveness ratio was ￡6212 per quality adjusted life year (QALY), with 92.5% probability of being below ￡20000 per QALY.Conclusion HepCATT had a modest impact but is a low cost intervention that merits optimisation and implementation as part of an NHS strategy to increase HCV testing and treatment.

DOI: 10.1136/bmj.m322

Source: https://www.bmj.com/content/368/bmj.m322