Cost effectiveness of screening for drug-induced liver injury
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Cost effectiveness of screening for drug-induced liver injury Paper-based point-of-care testing appears to be the most cost-effective screening strategy for identifying druginduced liver injury (DILI) due to antiretroviral and antitubercular therapy in patients with HIV/AIDS and tuberculosis (TB) in low- and middle-income countries (LMICs), according to findings of a study published in Clinical Infectious Diseases. A Markov model populated with data from Village Health Works, in a rural region in Burundi, was used to evaluate the cost effectiveness of electrochemical paper-base point-of-care (POC) finger-prick blood testing for ALT screening, or gold-standard laboratory testing for monitoring liver enzyme levels, compared with baseline clinical monitoring in 2223 HIV patients with viral suppression and comorbid TB who were initiating a 6-month course of antitubercular therapy. DILI was defined as ALT elevation over three times the upper limit of normal (ULN) with symptoms, or over five times the ULN with or without symptoms. Clinical monitoring was estimated to have a 32% success rate in identifying asymptomatic DILI and was associated with total costs of $264 389. Paper-based testing was estimated to achieve a 56% increase in efficacy in detecting DILI compared with clinical monitoring alone at an incremental total cost of $30 900 ($550 per additional percent efficacy), and gold-standard testing was estimated to achieve a 5% increase in efficacy compared with paper-based testing at cost of $1431 per additional efficacy percentage. In deterministic sensitivity analysis, paper-based testing was found to be more cost effective than gold-standard testing when the cost was less than $1.60 per paper-based test, but gold standard testing dominated (more effective and less costly) paper-based testing if the cost per paper test was $1.60 or greater. Probabilistic sensitivity testing found that paper-based POC testing was more cost-effective than clinical monitoring at willingness-to-pay thresholds over $570. "When gold-standard testing is not broadly implementable, policy makers can feel confident that paper-based testing adds significant benefit. Scientists and engineers should also keep these analyses in mind, trying to limit the cost of an ALT screening test to $1.60 per test," concluded the authors. Moed S, et al. Economic Evaluation of Screening Interventions for Drug Induced Liver Injury. Clinical Infectious Diseases : 8 Sep 2020. Available from: URL: http:// 803502472 doi.org/10.1093/cid/ciaa1347
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Reactions 19 Sep 2020 No. 1822
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