Screening for Hepatitis C in injecting drug users: a cost utility analysis

Area of Science:

• Hepatology
• Public Health
• Health Economics

Background:

• Hepatitis C virus (HCV) infection poses a significant public health challenge, particularly among individuals who inject drugs.
• Screening for HCV in this high-risk population has been proposed as a public health intervention.

Purpose of the Study:

• To estimate the cost utility of screening for Hepatitis C virus (HCV) infection.
• To evaluate screening among individuals with a history of injecting drug use accessing drug misuse services.

Main Methods:

• A spreadsheet-based model was developed to simulate screening using ELISA and polymerase chain reaction (PCR) tests.
• Treatment simulation involved combination therapy with interferon alpha and ribavirin.
• Model parameters were derived from literature reviews, expert opinions, and a survey of current screening practices in England.
• One-way sensitivity analyses were conducted to assess cost-effectiveness uncertainty.

Main Results:

• HCV screening is projected to yield benefits at approximately 28,000 pounds per quality-adjusted life year (QALY).
• The cost-effectiveness estimate remained relatively stable under sensitivity analyses.
• Key uncertainties influencing the results include patient acceptance of biopsy/treatment and utility gains from successful treatment.

Conclusions:

• Screening for HCV in the studied population is considered moderately cost-effective.
• Certain uncertainties, including the impact of competing mortality and the natural presentation of symptoms, warrant caution.
• Further research is recommended to refine the cost-effectiveness estimates in this field.