Systematic review: economic evaluations of HCV screening in the direct‐acting antivirals era

Abstract

Background:The World Health Organization estimated that 90% of the infected people need to be diagnosed and 80% need to be treated to reach the aim of hepatitis C virus (HCV) elimination by 2030. For this reason, all possible strategies to detect and treat HCV-infected people need to be carefully evaluated to implement the best one. Aim: To review and synthesise the economic evaluations of HCV screening programs conducted in the era of direct-acting antiviral agents regimens. Methods: A systematic literature review was conducted until April 2018 to provide information on the costs and effectiveness of HCV screenings in direct-acting antiviral agents era. A critical assessment of the quality of economic evaluations retrieved was conducted. Results: The literature search identified 716 references; 17 of them assessed cost and effectiveness of screening programs and antiviral treatments in different populations: general population (n = 7), drug users (n = 5), high-risk populations (n = 4) and other populations (n = 3). The HCV screening and direct-acting antiviral agents treatment appear to be good value for money, both in general and high-risk populations, if a cost per quality adjusted life years of $50 000 is set as willingness to pay threshold. Some studies showed the value of including lower stage of fibrosis in the treatment selection criteria.Conclusions: Several HCV screening strategies plus direct-acting antiviral agents treatments resulted cost-effectiveness in different populations. However, there is still need of country and population-specific evaluations within the different HCV screening and treatment strategies available, in order to assess their cost-effectiveness and sustainability and fully support an evidence-informed policy for HCV elimination.

Elimination of hepatitis C virus in Germany: modelling the cost-effectiveness of HCV screening strategies

“…Furthermore, we stratified hepatitis C infection rates by age, but not by sex, because there is no valid data on sex-specific prevalence rates in Germany. Disregarding gender-specific prevalence rates is quite usual in the international literature on population-based screening models [65]. Moreover, we would not expect considering sex-specific prevalence rates to have significant impact on the results of our model (the most potential impact might be expected for GEP, but with similar participation rates in check-up 35+ for both sexes considering gender-specific prevalence rates does almost not affect numbers of identified HCV infected persons).…”

Epidemiology of hepatitis C virus infection in a country with universal access to direct‐acting antiviral agents: Data for designing a cost‐effective elimination policy in Spain

“…However, when other possible budgetary scenarios for different European countries with treatment costs between 2 and 4 times higher than those established in Spain were contemplated, the cost‐effectiveness ratio remained within the acceptable limits for the screening and treatment of all age groups. One recent systematic review identified a total of seventeen studies that assessed the cost‐effectiveness of HCV screening and antiviral treatment programmes. Seven of these study subjects from the general population or a subgroup of the general population was based upon age.…”

Opportunistic co‐screening for HCV and COVID‐19‐related services: A creative response with a need for thoughtful reflection

“…5 Universal screening, while theoretically feasible and conceivably highly effective in identifying most HCV-infected persons, would put major organizational and financial hurdles in countries with low-to-moderate prevalence. [6][7][8] Hence, if appropriately conceived, focused screenings would identify a high rate of infected subjects, because of the higher infection rate related to risk factors, and simultaneously reduce onward viral transmission by allowing to clear HCV from those at higher risk of spreading the infection. [9][10][11][12][13] An important step in deciding on a mass screening program is to model the number of people with infection and their outcomes over time.…”

“…However, these estimations are not sufficient to query the cost‐effectiveness of a mass screening which requires Health Technology Assessment tools that evaluate the cost versus the long‐term efficacy of a public health intervention. With specific regard to HCV screening, it is evaluated as a cost‐effective intervention, including all screening and disease costs over time, in different countries and with particular regards in Italy, the best cost‐effectiveness profile was given by a graduated strategy 6–8 . Each strategy was weighted for the uncertainties on the prevalence values of active infection, evaluating the short‐mid and long‐term costs and benefits to the health system in the perspective of achieving the elimination by 2030 8 .…”