Cost-Effectiveness Analysis of Risk-Factor Guided and Birth-Cohort Screening for Chronic Hepatitis C Infection in the United States

Abstract

BackgroundNo consensus exists on screening to detect the estimated 2 million Americans unaware of their chronic hepatitis C infections. Advisory groups differ, recommending birth-cohort screening for baby boomers, screening only high-risk individuals, or no screening. We assessed one-time risk assessment and screening to identify previously undiagnosed 40–74 year-olds given newly available hepatitis C treatments.Methods and FindingsA Markov model evaluated alternative risk-factor guided and birth-cohort screening and treatment strategies. Risk factors included drug use history, blood transfusion before 1992, and multiple sexual partners. Analyses of the National Health and Nutrition Examination Survey provided sex-, race-, age-, and risk-factor-specific hepatitis C prevalence and mortality rates. Nine strategies combined screening (no screening, risk-factor guided screening, or birth-cohort screening) and treatment (standard therapy–peginterferon alfa and ribavirin, Interleukin-28B-guided (IL28B) triple-therapy–standard therapy plus a protease inhibitor, or universal triple therapy). Response-guided treatment depended on HCV genotype. Outcomes include discounted lifetime costs (2010 dollars) and quality adjusted life-years (QALYs).Compared to no screening, risk-factor guided and birth-cohort screening for 50 year-olds gained 0.7 to 3.5 quality adjusted life-days and cost $168 to $568 per person. Birth-cohort screening provided more benefit per dollar than risk-factor guided screening and cost $65,749 per QALY if followed by universal triple therapy compared to screening followed by IL28B-guided triple therapy. If only 10% of screen-detected, eligible patients initiate treatment at each opportunity, birth-cohort screening with universal triple therapy costs $241,100 per QALY. Assuming treatment with triple therapy, screening all individuals aged 40–64 years costs less than $100,000 per QALY.ConclusionsThe cost-effectiveness of one-time birth-cohort hepatitis C screening for 40–64 year olds is comparable to other screening programs, provided that the healthcare system has sufficient capacity to deliver prompt treatment and appropriate follow-on care to many newly screen-detected individuals.

Cost-effectiveness of screening for hepatitis C in Canada

“…Our analysis also assumed that the probability of being treated and the distribution of fibrosis stages for patients with chronic HCV infection in Canada were similar to those at a single tertiary care hospital (Toronto Western Hospital, University Health Network). In addition, similar to other published cohort simulation studies, 50,62,63 our analysis did not implicitly implement the time from diagnosis to treatment. Thus, the analyses cannot capture the full benefits or limitations for the time from diagnosis to treatment.…”

“…Eckman and colleagues 62 showed that it was cost-effective to screen for HCV and treat with boceprevir according to US guidelines (US$47 276 per QALY). Liu and associates 63 reported incremental costeffectiveness ratios of US$73 228 per QALY for universal birth cohort screening and treatment with peginterferon-ribavirin and US$59 835 per QALY for universal birth cohort screening and treatment with boceprevir. The authors of most of these studies concluded that it would be costeffective to offer 1-time screening for Americans born between 1945 and 1965.…”

Management of Chronic Hepatitis C Virus Infection: A Consensus Report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases

“…Risk faktörleri ve IL28B genotipleri dikkate alınarak yapılan incelemelerde üçlü tedavi maliyet-etkindir (44). Hafif fibrozu olan hastalarda tedavinin maliyetetkin olup olmayacağı bilinmemektedir.…”

12 weeks of interferon-based therapy is feasible in patients with hepatitis C-related cirrhosis and thrombocytopenia: A post hoc analysis of eltrombopag studies

“…Currently 12 weeks of IFNbased therapy in combination with sofosbuvir is recommended for cirrhotic patients infected by genotype 3 who represents a large share of HCV-infected patients in Western countries and India [6][7]28].…”

“…However, poor tolerance and the limited number of patients who are eligible for IFN regimens limits effective treatment for chronic HCV infection [6,7].…”