Cost-Effectiveness of One-Time Birth Cohort Screening for Hepatitis C as Part of the National Health Service Health Check Program in England

Abstract

Background and Objectives: Birth cohort screening for the hepatitis C virus (HCV) has been implemented in the US, but there is little evidence of its cost-effectiveness in England. We aim to evaluate the cost-effectiveness of one-time HCV screening for individuals born between 1950 and 1979 as part of the National Health Service health check in England, a health check for adults aged 40 to 74 years in primary care. Methods: A Markov model was developed to analyze add-on HCV testing to the National Health Service health check for individuals in birth cohorts between 1950 and 1979, versus current background HCV testing only, over a lifetime horizon. The model used data from a back-calculation model of the burden of HCV in England, sentinel surveillance of HCV testing, and published literature. Results are presented from a health service perspective in pounds in 2017, as incremental cost-effectiveness ratios per quality-adjusted life years gained. Results: The base-case incremental cost-effectiveness ratios ranged from £7648 to £24 434, and £18 681 to £46 024, across birth cohorts when considering 2 sources of HCV transition probabilities. The intervention is most likely to be cost-effective for those born in the 1970s, and potentially cost-effective for those born from 1955 to 1969. The model results were most sensitive to the source of HCV transition probabilities, the probability of referral and receiving treatment, and the HCV prevalence among testers. The maximum value of future research across all birth cohorts was £11.3 million at £20 000 per quality-adjusted life years gained. Conclusion: Birth cohort screening is likely to be cost-effective for younger birth cohorts, although considerable uncertainty exists for other birth cohorts. Further studies are warranted to reduce uncertainty in cost-effectiveness and consider the acceptability of the intervention.

Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT): cluster randomised controlled trial in primary care

“…An alternative, and possibly complementary, approach is to conduct birth cohort screening, whereby all patients born between specific years (such as 1945 to 1965 as recommended by the Centers for Disease Control and Prevention in the US) are invited to be screened for HCV 3334. An economic model suggests that adding HCV screening to the NHS health check for people aged 45 to 70 could be cost effective, although no empirical evidence yet supports such a change 35…”

Model-based cost-effectiveness estimates of testing strategies for diagnosing hepatitis C virus infection in Central and Western Africa

“…Despite the importance of HCV diagnosis within the HCV care cascade, most recent CEAs dealing with hepatitis C have focused only on DAAs. Those including the issue of HCV testing aimed to determine, considering the high prices of DAAs, how broadly HCV treatment could be scaled up while remaining cost-effective, for instance by comparing risk-based testing with universal testing, or no screening at all [14][15][16][17][18][19]. Besides, the vast majority of these studies took place in high-income countries [20].…”

Cost-effectiveness of chronic hepatitis C screening and treatment

“…Unlike the USA and Japan, the prevalence of HCV infection in England is relatively low, with only 143,000 people estimated to be living with HCV infection in 2015 [ 39 ]. Another study evaluated the cost-effectiveness of a one-time HCV screening intervention for individuals born between 1950 and 1979, as part of a National Health Service health check [ 40 ]. The base-case ICER values ranged from USD 10,408 to USD 33,411, with the lowest ICER observed for people born between 1970 and 1974 and the highest ICER observed for people born between 1950 and 1954.…”