| Summary: | 碩士 === 國立臺灣大學 === 財務金融組 === 99 === Background
Transmission of hepatitis C virus (HCV) via needle stick injury from patients to health-care workers has been well documented. Different follow-up programs for this occupational exposure have been available in different countries. In this study, using a cost-effectiveness analysis, we compared the existing follow-up strategies recommended in Taiwan (wait-and-see) and the USA (early detection).
Methods
A decision tree simulated these two strategies for 1263 healthcare workers (HCWs) exposed to HCV each year in Taiwan, from exposure to death. Results of a cost-effectiveness analysis concerning the treatment of chronic hepatitis C (CHC) in Taiwan were used to estimate associated parameters once spontaneous resolution did not develop after six months.
Results
For a HCV transmission risk of 0.5% after exposure, the USA strategy could avert 3.6 CHC cases by extra cost NTD 220,136 per case. Taking together all the costs in treating CHC, the US strategy was dominant with an incremental QALYs 15.8 and cheaper cost. In a cost-benefit analysis, the US strategy had a positive net benefit and carried a benefit-cost ratio 1.26.
Conclusion
The US strategy based on early HCV-RNA testing could provide early diagnosis and treatment of acute occupational hepatitis C. This strategy also leads to lower risk of progression to CHC and is dominantly cost-effective.
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