The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings

Rein, David B.; Smith, Bryce D.; Wittenborn, John S.; Lesesne, Sarah B.; Wagner, L. Danielle; Roblin, Douglas W.; Patel, Nita; Ward, John W.; Weinbaum, Cindy M.

doi:10.7326/0003-4819-156-4-201202210-00378

Cited by 278 publications

(271 citation statements)

References 58 publications

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“…Based on these data and their own cost-effectiveness analysis, the Centers for Disease Control and Prevention (CDC) recommends routine screening of all baby boomers for HCV, in addition to screening based on risk factors. 7 In Canada, less is known about the prevalence of HCV infection. The Public Health Agency of Canada (PHAC) estimates that about 250 000 Canadians, or 0.8% of the population, are infected with HCV.…”

Section: What Is the Rate Of Hcv Infection In Canada?mentioning

confidence: 99%

“…Using the number of positive test results (192 225) 7 and underdiagnosis is highly prevalent even among people with insurance and access to care. 11 Data from Europe show a similar pattern.…”

Section: Are Canadian Data Accurate?mentioning

confidence: 99%

“…The CDC's analysis found that HCV screening was cost-effective Analysis based on standard "willingness to pay" thresholds for the cost per life-year saved. 7 Overall, it is probable that birth-cohort screening will be more cost-effective in Canada than in the US; however, we must also perform budget-impact analysis to determine whether our health care system can afford to adopt such a policy.…”

Section: Can We Afford Population Screening?mentioning

confidence: 99%

“…Two detailed economic analyses of birth-cohort screening compared with risk-based screening in the US found that birth-cohort screening was cost-effective, with incremental cost-effectiveness ratios of US$35 700 and $37 700 per qualityadjusted life-year gained; these estimates are similar to those for mammography screening for breast cancer among women over age 50 (incremental cost-effectiveness ratio US$35 500). 7,22,23 It would certainly be helpful to apply Canadian cost data to formally evaluate birth-cohort screening for HCV, but given the lower treatment costs and universal access to care for those with end-stage liver disease, it is likely to be even more cost-effective. …”

mentioning

confidence: 99%

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A Canadian screening program for hepatitis C: Is now the time?

Shah

Heathcote

Feld

2013

CMAJ

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Analysis CMAJ• Hepatitis C virus (HCV) infection has an enormous impact on population health in Canada and is likely underdiagnosed.• A national strategy to screen for and treat HCV infections would substantially reduce HCV-related morbidity and mortality.• Birth-cohort screening of people born between 1945 and 1975 coupled with a strategy for follow-up treatment and education is probably the best method to identify and provide care to affected people in Canada.• Population-level data on the prevalence and health impact of HCV infection are needed in Canada. Key points © 2013 Canadian Medical Association or its licensorsCMAJ, October 15, 2013, 185(15) 1325 markedly lower than in countries with active surveillance programs for HCV, and, if correct, would place Canada among the top countries in the world at diagnosing HCV infections despite not having a national screening program. The CDC estimates that 63% of Americans with HCV are unaware of their infection, 7 and underdiagnosis is highly prevalent even among people with insurance and access to care.11 Data from Europe show a similar pattern. Before introducing an intensive national program, 75% of infected individuals in France were unaware of their infection; after introduction of this program, the rate decreased to 44%. 12 Given that it took a major national effort in France to get the diagnosis rate to 56%, it seems unlikely that Canada's estimate that 79% of infected individuals are aware of their diagnosis is correct.The Canadian data may be inaccurate for 2 major reasons. First, diagnosed cases may have been inadvertently counted more than once. Second, and more importantly, the overall prevalence may be considerably higher than estimated, particularly because groups at high risk of HCV infection are often undersampled. With the same number of positive test results, a higher prevalence would lead to a lower diagnosis rate. If Canadian data are similar to those in countries with comparable health care systems (e.g., France), the rate of underdiagnosis is likely much higher than 21%, and strategies to decrease this rate are needed. What are the benefits and risks of screening?Hepatitis C virus meets the criteria for a condition for which screening specific populations is potentially useful. There are many benefits: HCV is a major cause of morbidity and mortality; the prevalence of HCV is increased among baby boomers; many individuals are unaware that they are infected; and HCV infection is curable, with early intervention leading to improved overall health outcomes. Patients whose infection has been eradicated before cirrhosis develops have a life expectancy similar to that of uninfected people.13 If cirrhosis develops before treatment, viral eradication eliminates the risk of liver failure and markedly reduces the risk of hepatocellular cancer. 3,13 There are potential risks associated with screening, including individuals feeling stigmatized by being "targeted," false positive results and a lack of capacity to treat the volume of newly diagnosed cases. ...

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Section: What Is the Rate Of Hcv Infection In Canada?mentioning

confidence: 99%

Section: Are Canadian Data Accurate?mentioning

confidence: 99%

Section: Can We Afford Population Screening?mentioning

confidence: 99%

mentioning

confidence: 99%

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A Canadian screening program for hepatitis C: Is now the time?

Shah

Heathcote

Feld

2013

CMAJ

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“…QALYs are derived from utility loss estimates from five studies based on HCV states F0‐1, F2‐3, CC, DC, HCC, postliver transplant, and post‐SVR 17, 18, 19, 20, 21, 22. QALYs are calculated by multiplying annual stage utility losses by expected background utility based on age for each year of life 23…”

Section: Methodsmentioning

confidence: 99%

Potential epidemiologic, economic, and budgetary impacts of current rates of hepatitis C treatment in medicare and non‐medicare populations

Wittenborn

Brady

Dougherty

et al. 2017

Hepatology Communications

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We forecast the health and budgetary impact of hepatitis C (HCV) treatment on the Medicare program based on currently observed rates of treatment among Medicare and non‐Medicare patients and identify the impact of higher rates of treatment among non‐Medicare populations. We developed a computer microsimulation model to conduct an epidemiologic forecast, a budgetary impact analysis, and a cost‐effectiveness analysis of the treatment of HCV based on three scenarios: 1) no treatment, 2) continuation of current‐treatment rates, and 3) treatment rates among non‐Medicare patients increased to match that of Medicare patients. The simulated population is based on National Health and Nutrition Examination Survey data. HCV progression rates and costs were calculated in Surveillance, Epidemiology, and End Results Program Medicare 5% claims data from the Chronic Hepatitis Cohort Study and published literature. We estimate that 13.6% of patients with HCV in the United States are enrolled in Medicare, but 75% will enter Medicare in the next 20 years. Medicare patients were over 5 times as likely to be treated in 2014‐2015 as other patients. Medicare paid over $9 billion in treatment costs in both 2015 and 2016 and will total $28.4 billion from 2017‐2026. Increasing treatment rates among non‐Medicare patients would lead to 234,000 more patients being treated, reduce HCV mortality by 19%, and decrease Medicare costs by $18.6 billion from 2017‐2026. We find that treatment remains cost‐effective under most assumptions, costing $31,718 per quality adjusted life year gained. Conclusion: Medicare treats a disproportionately large share of HCV patients. Continued low rates of treatment among non‐Medicare HCV patients will result in both reduced and deferred treatment, shifting future treatment costs to Medicare while increasing overall medical management costs, morbidity, and mortality. (Hepatology Communications 2017;1:99‐109)

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