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 in | Liver international Vol. 40; no. 7; pp. 1545 - 1555 |
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Main Authors | , , , , , , , , , , |
Format | Journal Article |
Language | English |
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United States
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01.07.2020
John Wiley and Sons Inc |
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Abstract | 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 |
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AbstractList | 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.
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.
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.
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 Background and AimsCost‐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.MethodsA 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.ResultsA 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.ConclusionsIn 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. 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.BACKGROUND AND AIMSCost-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.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.METHODSA 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.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.RESULTSA 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.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.CONCLUSIONSIn 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. 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 Abstract 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 |
Author | Blach, Sarah Razavi, Homie Craxi, Antonio Gamkrelidze, Ivane Puoti, Massimo Marcellusi, Andrea Galli, Massimo Vella, Stefano Petta, Salvatore Kondili, Loreta A. Mennini, Francesco S. |
AuthorAffiliation | 4 Department of Accounting Finance and Informatics Kingston Business School Kingston University London UK 1 Center for Global Health Istituto Superiore di Sanità Rome Italy 5 Department of Biomedical and Clinical Sciences “L Sacco” University of Milan Milan Italy 7 Department of Infectious Diseases ASST Grande Ospedale Metropolitano Niguarda Milan Italy 2 Center for Disease Analysis Foundation Lafayette CO US 3 Centre for Economic and International Studies Faculty of Economics University of Rome Tor Vergata Rome Italy 6 Gastroenterology and Liver Unit, PROMISE University of Palermo Palermo Italy |
AuthorAffiliation_xml | – name: 2 Center for Disease Analysis Foundation Lafayette CO US – name: 7 Department of Infectious Diseases ASST Grande Ospedale Metropolitano Niguarda Milan Italy – name: 4 Department of Accounting Finance and Informatics Kingston Business School Kingston University London UK – name: 6 Gastroenterology and Liver Unit, PROMISE University of Palermo Palermo Italy – name: 1 Center for Global Health Istituto Superiore di Sanità Rome Italy – name: 5 Department of Biomedical and Clinical Sciences “L Sacco” University of Milan Milan Italy – name: 3 Centre for Economic and International Studies Faculty of Economics University of Rome Tor Vergata Rome Italy |
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ContentType | Journal Article |
Copyright | 2020 The Authors. published by John Wiley & Sons Ltd 2020 The Authors. Liver International published by John Wiley & Sons Ltd. 2020. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. |
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Keywords | cost-effectiveness screening HCV WHO targets |
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Notes | 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. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Available in www.progettopiter.it. Loreta A. Kondili and Ivane Gamkrelidze should be considered as joint first authors. Handling Editor: Benjamin Maasoumy |
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Cost‐effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort... Cost-effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost-effective... Abstract Background and Aims Cost‐effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth... Background and AimsCost‐effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort... See Editorial on Page 1538 |
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SubjectTerms | 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 |
Title | Optimization of hepatitis C virus screening strategies by birth cohort in Italy |
URI | https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fliv.14408 https://www.ncbi.nlm.nih.gov/pubmed/32078234 https://www.proquest.com/docview/2415666670/abstract/ https://www.proquest.com/docview/2359434397/abstract/ https://pubmed.ncbi.nlm.nih.gov/PMC7384106 |
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