HCV Screening to Enable Early Treatment of Hepatitis C: A athematical Model to Analyse Costs and Outcomes in Two Populations

Abstract

Early treatment of acute hepatitis C virus (HCV) infections reflects a new clinical paradigm and a significant option to reduce the socioeconomic burden of HCV. Therefore, this approach seems suitable as a new strategy to face HCV and prevent end stage liver diseases and premature deaths due to progressed chronic HCV-infections. The main limitation of this approach is that the majority of acute infections show an asymptomatic course and do thus not present to the health-care settings. Screening for HCV has already been extensively studied in the literature. This paper offers further insights in screening for HCV using cost effectiveness analysis for the impact of screening in two cohorts: Injecting Drug Users (IDUs) and Individuals With Surgery (IWSs). The setting of the cost effectiveness simulation is the Veneto Region in the North-east of Italy. Using a Markov model of the natural history of HCV infection we derive costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness related to screening vs. no-screening strategies. In the IDUs cohort, the screening strategy can result in a substantial difference in premature deaths and dominates (less costs better outcomes) the no-screening one. The overall outcomes of the screening strategy are mostly affected by the prevalence of HCV and of genotypes that are more relatively more difficult to treat (above 10% of prevalence for its cost effectiveness). The number of premature deaths prevented in the IWSs cohort is lower and there seems to be an unacceptable incremental cost per QALY gained, which may be unsustainable for society.

Cost Effectiveness of Screening Strategies for Early Identification of HIV and HCV Infection in Injection Drug Users

“…To our knowledge, no previous study has considered the cost effectiveness of routine screening for acute HIV infection in IDUs. Our results differ from the one study that considered the cost effectiveness of screening IDUs for acute/early HCV infection; that study found antibody screening every 6 months and initiation of treatment to be highly cost effective and potentially cost-saving [122]. However, that study assumed that 100% of identified cases among IDUs would be eligible for PEG-IFN+RBV treatment and did not include the possibility of re-infection, which is known to occur [123].…”

Infection with hepatitis B and C virus in Europe: a systematic review of prevalence and cost-effectiveness of screening

“…However, no costs for the screening programme were taken into account and compliance was set at an unrealistic 100%. Five economic analyses of HCV screening of other population subgroups were found [48,50,63,65,66,74]. Both studies that considered screening programmes targeting several population subgroups concluded that the specific programmes considered were potentially cost-effective [50,66].…”

“…Josset et al reported estimated costs per positive test result for 6 screening scenarios, which varied regarding population subgroups targeted [63]. Analyses of HCV screening of people transfused before 1991 in France and of people with a history of surgery in Italy both concluded this was not cost-effective [48,65]. …”

Applying a system approach to forecast the total hepatitis C virus‐infected population size: model validation using US data

“…Considerable work has been undertaken to forecast the epidemiology of hepatitis C and numerous authors have developed Markov models to estimate the disease burden (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). However, these models have limitations resulting from the assumption that the studied cohorts remain homogeneous and traverse through different states at a fixed rate over time when, in reality, populations are very heterogeneous (17).…”