Cost-effectiveness of screening for hepatitis C in Canada

Abstract

Background:The seroprevalence of hepatitis C virus (HCV) infection among Canadians is estimated at 0.3% to 0.9%. Of those with chronic HCV infection, 10% to 20% will experience advanced liver disease by 30 years of infection. Targeted screening seems a plausible strategy. We aimed to estimate the health and economic effects of various screening and treatment strategies for chronic HCV infection in Canada. Methods:We used a state-transition model to examine the cost-effectiveness of 4 screening strategies: no screening; screen and treat with pegylated interferon plus ribavarin; screen and treat with pegylated interferon and ribavarinbased direct-acting antiviral agents; and screen and treat with interferon-free direct-acting antivirals. We considered Can adian residents in 2 age groups: 25-64 and 45-64 years of age. We obtained model data from the literature. We predicted deaths related to chronic HCV infection, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios. Results:We found that screening and treating would prevent at least 9 HCV-related deaths per 10 000 persons screened over the lifetime of the cohort. Screening was associated with QALY increases of 0.0032 to 0.0095 and cost increases of $124 to $338 per person, which translated to an incremental cost-effectiveness ratio of $34 359 to $44 034 per QALY gained, relative to no screening, depending on age group screened and antiviral therapy received.Interpretation: A selective one-time HCV screening program for people 25-64 or 45-64 years of age in Canada would likely be cost-effective. Identification of silent cases of chronic HCV infection and the offer of treatment when appropriate could extend the lives of Canadians at reasonable cost. Abstract Research E111CMAJ, February 17, 2015, 187(3)

Recommendations on hepatitis C screening for adults

“…2) the possibility that the baseline risk of disease progression used for the model (based on nonscreened populations) 27 is higher than that for the asymptomatic screened population, 4,28 which would translate into an overestimation of the benefit of screening, 3) an inability to take into consideration the harms of overdiagnosis and overtreatment that result from screening, and 4) the inherent inability of modelling to account for unknown factors that may influence screening outcomes.…”

Hospital stays for hepatitis B or C virus infection or primary liver cancer among immigrants: a census-linked population-based cohort study

“…This has implications for potential HCV screening strategies. 33 The results of multivariate logistic regression analyses suggest that, in general, there was a duration effect, as the healthy immigrant effect diminished over time. This likely reflects the fact that recent immigrants were considerably younger than those who had been in Canada longer (mean age 39 v. 54 years) and that most liver diseases, including HBV and HCV infection, typically require decades to progress to advanced stages.…”

A hepatitis C-vírus-fertőzés és kezelésének költségvonzata

“…Child A cirrhosis mellett az AbbVie3D (európai ismert kúraköltség 13 millió forint/12 hét), míg Child B esetén a sofosbuvir és ledipasvir kombináció (európai ismert kúraköltség 16 millió forint/12 hét) alkalmazása jöhet szóba [32]. Mivel SVR esetén a megnyert minőségi életév 4 feletti, ezért 1 minő-ségi életévnyereség még a legdrágább kezelés mellett is 4 millió forint alatt, jóval a nemzetközileg elfogadott határ (20 000-120 000 USD/QALY) alá kerül [33]. Jelenleg nincsenek pontos adataink arra vonatkozóan, hogy a frissen felfedezett betegek hány százaléka rendelkezik interferon-ellenjavallattal, illetve hány százalékuk Child B stá-diumú.…”