Cost-effectiveness and Population Outcomes of General Population Screening for Hepatitis C

• Published in: Clinical infectious diseases Vol. 54; no. 9; pp. 1259 - 1271
• Main Authors: Coffin, Phillip O., Scott, John D., Golden, Matthew R., Sullivan, Sean D.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.05.2012
• Subjects: Adult; Aged; and Commentaries; ARTICLES AND COMMENTARIES; Biological and medical sciences; Chronic hepatitis; Cirrhosis; Cost-Benefit Analysis; Decision Support Techniques; Female; Fibrosis; Genotype; Genotype & phenotype; Genotypes; Hepacivirus; Hepacivirus - isolation & purification; Hepatitis; Hepatitis C; Hepatitis C - complications; Hepatitis C - diagnosis; Hepatitis C - economics; Hepatitis C - epidemiology; Hepatocellular carcinoma; Human viral diseases; Humans; Infections; Infectious diseases; Liver; Liver Cirrhosis - diagnosis; Liver Cirrhosis - economics; Liver Cirrhosis - epidemiology; Liver Cirrhosis - virology; Male; Markov Chains; Mass Screening - economics; Medical diagnosis; Medical sciences; Medical screening; Middle Aged; Monte Carlo simulation; Mortality; Predisposing factors; Protease inhibitors; Protease Inhibitors - therapeutic use; Quality-Adjusted Life Years; Risk Factors; Sensitivity and Specificity; United States - epidemiology; Viral diseases; Viral hepatitis; Young Adult; United States; United States > US; Infection; Prognosis; Health economy; Viral disease; Digestive diseases; Hepatic disease; Medical screening; Public health; Cost efficiency analysis; Viral hepatitis C
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cis011

Background. Current US guidelines recommend limiting hepatitis C virus (HCV) screening to high-risk individuals, and 50%—75% of infected persons remain unaware of their status. Methods. To estimate the cost-effectiveness and population-level impact of adding one-time HCV screening of US population aged 20—69 years to current guidelines, we developed a decision analytic model for the screening intervention and Markov model with annual transitions to estimate natural history. Subanalyses included protease inhibitor therapy and screening those at highest risk of infection (birth year 1945—1965). We relied on published literature and took a lifetime, societal perspective. Results. Compared to current guidelines, incremental cost per quality-adjusted life year gained (ICER) was $7900 for general population screening and $4200 for screening by birth year, which dominated general population screening if cost, clinician uptake, and median age of diagnoses were assumed equivalent. General population screening remained cost-effective in all one-way sensitivity analyses, 30 000 Monte Carlo simulations, and scenarios in which background mortality was doubled, all genotype 1 patients were treated with protease inhibitors, and most parameters were set unfavorable to increased screening. ICER was lowest if screening was applied to a population with liver fibrosis similar to 2010 estimates. Approximately 1% of liver-related deaths would be averted per 15% of the general population screened; the impact would be greater with improved referral, treatment uptake, and cure. Conclusions. Broader screening for HCV would likely be cost-effective, but significantly reducing HCV-related morbidity and mortality would also require improved rates of referral, treatment, and cure.