{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T05:16:52Z","timestamp":1790140612509,"version":"4.0.1"},"reference-count":74,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,5,2]],"date-time":"2023-05-02T00:00:00Z","timestamp":1682985600000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Roche Molecular Systems, Inc","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,3,31]]},"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Pakistan has a hepatitis C virus (HCV) infection prevalence of 6%\u20139% and aims to achieve World Health Organisation (WHO) targets for elimination of HCV by the year 2030. We aim to evaluate the potential cost-effectiveness of a reference laboratory-based (centralised laboratory testing; CEN) confirmatory testing approach versus a molecular near-patient point-of-care (POC) confirmatory approach to screen the general population for HCV in Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>We used a decision tree-analytic model from a governmental (formal healthcare sector) perspective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study setting<\/jats:title>\n                    <jats:p>Individuals were assumed to be initially screened with an anti-HCV test at home, followed by POC nucleic acid test (NAT) at nearby district hospitals or followed by NAT at centralised laboratories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We included the general testing population for chronic HCV in Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Screening with an anti-HCV antibody test (Anti-HCV) followed by either POC NAT (Anti-HCV-POC), or reference laboratory NAT (Anti-HCV-CEN), was compared, using data from published literature and the Pakistan Ministry of Health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>Outcome measures included: number of HCV infections identified per year, percentage of individuals correctly classified, total costs, average costs per individual tested, and cost-effectiveness (assessed as cost per additional HCV infection identified). Sensitivity analysis was also performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At a national level (25\u2009million annual screening tests), the Anti-HCV-CEN strategy would identify 142\u2009406 more HCV infections in 1\u2009year and increase correct classification of individuals by 0.57% compared with the Anti-HCV-POC strategy. The total annual cost of HCV testing was reduced using the Anti-HCV-CEN strategy by US$7.68\u2009million (US$0.31\/person). Thus, incrementally, the Anti-HCV-CEN strategy costs less and identifies more HCV infections than Anti-HCV-POC. The incremental difference in HCV infections identified was most sensitive to the probability of loss to follow-up (for POC confirmatory NAT).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Anti-HCV-CEN would provide the best value for money when scaling up HCV testing in Pakistan.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-066770","type":"journal-article","created":{"date-parts":[[2023,5,4]],"date-time":"2023-05-04T11:08:01Z","timestamp":1683198481000},"page":"e066770","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Assessing the potential cost-effectiveness of centralised versus point-of-care testing for hepatitis C virus in Pakistan: a model-based comparison"],"prefix":"10.1136","volume":"13","author":[{"given":"Joseph B","family":"Babigumira","sequence":"first","affiliation":[{"name":"Saw Swee Hock School of Public Health, National University of Singapore, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2052-4659","authenticated-orcid":false,"given":"James K","family":"Karichu","sequence":"additional","affiliation":[{"name":"Roche Molecular Systems Inc, Pleasanton, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Clark","sequence":"additional","affiliation":[{"name":"The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington Seattle Campus, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy M","family":"Cheng","sequence":"additional","affiliation":[{"name":"Roche Molecular Systems Inc, Pleasanton, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis P","family":"Garrison","sequence":"additional","affiliation":[{"name":"The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington Seattle Campus, Seattle, Washington, USA"},{"name":"VeriTech Corporation, Mercer Island, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej B","family":"Maniecki","sequence":"additional","affiliation":[{"name":"Roche Molecular Systems Inc, Pleasanton, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed S","family":"Hamid","sequence":"additional","affiliation":[{"name":"The Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,5,4]]},"reference":[{"key":"2025121512113993000_13.5.e066770.1","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/S2468-1253(16)30181-9","article-title":"Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study","volume":"2","year":"2017","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2025121512113993000_13.5.e066770.2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26141"},{"key":"2025121512113993000_13.5.e066770.3","unstructured":"World Health Organisation. 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