Cost Effectiveness of Screening Strategies for Early Identification of HIV and HCV Infection in Injection Drug Users 英文参考文献.docVIP

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Cost Effectiveness of Screening Strategies for Early Identification of HIV and HCV Infection in Injection Drug Users 英文参考文献.doc

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Cost Effectiveness of Screening Strategies for Early Identification of HIV and HCV Infection in Injection Drug Users 英文参考文献

CostEffectivenessofScreeningStrategiesforEarly IdentificationofHIVandHCVInfectioninInjectionDrug Users LaurenE.Cipriano1*,GregoryS.Zaric2,MarkHolodniy3,4,5,EranBendavid4,5,6,7,DouglasK.Owens3,4,7 , MargaretL.Brandeau1 1DepartmentofManagementScienceandEngineering,StanfordUniversity,Stanford,California,UnitedStatesofAmerica,2RichardIveySchoolofBusiness,Universityof WesternOntario,London,Ontario,Canada,3VeteransAffairsPaloAltoHealthCareSystem,PaloAlto,California,UnitedStatesofAmerica,4DepartmentofMedicine, StanfordUniversity,Stanford,California,UnitedStatesofAmerica,5DivisionofInfectiousDiseasesGeographicMedicine,StanfordUniversity,Stanford,California,United StatesofAmerica,6DivisionofGeneralMedicineDisciplines,StanfordUniversity,Stanford,California,UnitedStatesofAmerica,7CenterforHealthPolicyandCenterfor PrimaryCareandOutcomesResearch,DepartmentofMedicine,StanfordUniversity,Stanford,California,UnitedStatesofAmerica Abstract Objective: To estimate the cost, effectiveness, and cost effectiveness of HIV and HCV screening of injection drug users (IDUs)inopioidreplacementtherapy(ORT). Design: Dynamic compartmental model of HIV and HCV in a population of IDUs and non-IDUs for a representative U.S. urbancenterwith2.5millionadults(age15–59). Methods:WeconsideredstrategiesofscreeningindividualsinORTforHIV,HCV,orbothinfectionsbyantibodyorantibody andviralRNAtesting.Weevaluatedone-timeandrepeatscreeningatintervalsfromannuallytoonceevery3months.We calculated the number of HIV and HCV infections, quality-adjusted life years (QALYs), costs, and incremental cost- effectivenessratios(ICERs). Results: Adding HIV andHCVviral RNA testing toantibody testing averts 14.8–30.3HIV and 3.7–7.7 HCVinfections in a screened population of 26,100 IDUs entering ORT over 20 years, depending on screening frequency. Screening for HIV antibodiesevery6monthscosts$30,700/QALYgained.ScreeningforHIVantibodiesandviralRNAevery6monthshasan ICER of $65,900/QALY gained. Strategies including HCV testing have I