Optimization of hepatitis C virus screening strategies by birth cohort in Italy

Background and Aims Cost‐effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost‐effective in Italy. Methods A model was developed to quantify screening and healthcare costs associated with HCV. The model‐estima...

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Published inLiver international Vol. 40; no. 7; pp. 1545 - 1555
Main Authors Kondili, Loreta A., Gamkrelidze, Ivane, Blach, Sarah, Marcellusi, Andrea, Galli, Massimo, Petta, Salvatore, Puoti, Massimo, Vella, Stefano, Razavi, Homie, Craxi, Antonio, Mennini, Francesco S.
Format Journal Article
LanguageEnglish
Published United States Wiley Subscription Services, Inc 01.07.2020
John Wiley and Sons Inc
Subjects
Antibodies
Antiviral Agents - therapeutic use
Cost-Benefit Analysis
cost‐effectiveness
HCV
Hepacivirus
Hepatitis
Hepatitis C
Hepatitis C - diagnosis
Hepatitis C - drug therapy
Hepatitis C - epidemiology
Hepatitis C, Chronic - diagnosis
Hepatitis C, Chronic - drug therapy
Hepatitis C, Chronic - epidemiology
Humans
Italy - epidemiology
Liver Disease and Public Health
Mass Screening
Optimization
Original
Quality-Adjusted Life Years
screening
Strategy
Viruses
WHO targets
Italy
cost-effectiveness
screening
HCV
WHO targets
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Summary:Background and Aims Cost‐effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost‐effective in Italy. Methods A model was developed to quantify screening and healthcare costs associated with HCV. The model‐estimated prevalence of undiagnosed HCV was used to calculate the antibody screens needed annually, with a €25 000 cost‐effectiveness threshold. Outcomes were assessed under the status quo and a scenario that met the World Health Organization's targets for elimination of HCV. The elimination scenario was assessed under five screening strategies. Results A graduated birth cohort screening strategy (graduated screening 1: 1968‐1987 birth cohorts, then expanding to 1948‐1967 cohorts) was the least costly. This strategy would gain approximately 144 000 quality‐adjusted life years (QALYs) by 2031 and result in an 89.3% reduction in HCV cases, compared to an 89.6%, 89.0%, 89.7% and 88.7% reduction for inversed graduated screening, 1948‐77 birth cohort, 1958‐77 birth cohort and universal screening, respectively. Graduated screening 1 yielded the lowest incremental cost‐effectiveness ratio (ICER) of €3552 per QALY gained. Conclusions In Italy, a graduated screening scenario is the most cost‐effective strategy. Other countries could consider a similar birth cohort approach when developing HCV screening strategies. See Editorial on Page 1538
Bibliography:Funding information
This study was partially supported by the Italian Ministry of Health Grant Number RF‐2016‐02364053 and by a Research Grant from the University of Tor Vergata Rome. The funding source had no role in the study design, the collection, analysis and interpretation of the data, in the writing of the report and in the decision to submit the paper for publication.
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Available in www.progettopiter.it.
Loreta A. Kondili and Ivane Gamkrelidze should be considered as joint first authors.
Handling Editor: Benjamin Maasoumy
ISSN:1478-3223
1478-3231
1478-3231
DOI:10.1111/liv.14408