No abstract

Recent research has identified high hepatitis C virus (HCV) prevalence among older U.S. residents who contracted HCV decades ago and may no longer be recognized as high risk.We assessed the cost-effectiveness of screening 100% of U.S. residents born 1946-1970 over 5 years (birth-cohort screening), compared with current risk-based screening, by projecting costs and outcomes of screening over the remaining lifetime of this birth cohort. A Markov model of the natural history of HCV was developed using data synthesized from surveillance data, published literature, expert opinion, and other secondary sources. We assumed eligible patients were treated with pegylated interferon plus ribavirin, with genotype 1 patients receiving a direct-acting antiviral in combination. The target population is U.S. residents born 1946-1970 with no previous HCV diagnosis. Among the estimated 102 million (1.6 million chronically HCV infected) eligible for screening, birth-cohort screening leads to 84,000 fewer cases of decompensated cirrhosis, 46,000 fewer cases of hepatocellular carcinoma, 10,000 fewer liver transplants, and 78,000 fewer HCV-related deaths. Birth-cohort screening leads to higher overall costs than risk-based screening ($80.4 billion versus $53.7 billion), but yields lower costs related to advanced liver disease ($31.2 billion versus $39.8 billion); birth-cohort screening produces an incremental costeffectiveness ratio (ICER) of $37,700 per quality-adjusted life year gained versus riskbased screening. Sensitivity analyses showed that reducing the time horizon during which health and economic consequences are evaluated increases the ICER; similarly, decreasing the treatment rates and efficacy increases the ICER. Model results were relatively insensitive to other inputs. Conclusion: Birth-cohort screening for HCV is likely to provide important health benefits by reducing lifetime cases of advanced liver disease and HCV-related deaths and is cost-effective at conventional willingness-topay thresholds. (HEPATOLOGY 2012;55:1344-1355 H epatitis C virus (HCV) is the most common blood-borne viral infection in the United States, 1 affecting an estimated 3.6 million U.S. residents.2 The majority of infected individuals develop chronic hepatitis; persistent liver injury leads to cirrhosis in 5%-30% of cases 3 and may progress to advanced liver disease (AdvLD), which includes decompensated cirrhosis or hepatocellular carcinoma (HCC), leading to liver transplant and premature death. Costs of HCV in the United States are estimated to exceed $5 billion per year, 4 with projected HCV-related societal costs for the years 2010-2019 estimated to total $54.2 billion. 5For the last decade, the standard of care for treating HCV has been the combination of pegylated interferon (Peg-IFN) and ribavirin (RBV), 6 which successfully eradicates virus (sustained virologic response; SVR) in 40%-80% of treated patients. 7 This response is 40%-50% in patients with HCV genotype 1 and 80% for patients infected with HCV genotypes 2 and 3. However, the rece...

No abstract

This study provides updated estimates of medical care costs of cardiovascular events among a managed care population over various time horizons. Results suggest that the economic burden of cardiovascular disease is substantial, both in the acute phase as well as over the longer term.