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Case finding for hepatitis C in primary care: a cost utility analysis
Joanna Thompson Coon1, Emanuela Castelnuovo, Martin Pitt
1Peninsula Technology Assessment Group, Peninsula Medical School, University of Exeter, Noy Scott House, Barrack Road, Exeter, EX2 5DW, UK. Joanna.Thompson-Coon@pentag.nhs.uk
Family Practice
|June 27, 2006
Summary
Identifying hepatitis C (HCV) in primary care among former injecting drug users (IDUs) appears cost-effective. This proactive case finding offers a high probability of being cost-effective, though further research is recommended.
Area of Science:
- Public Health
- Health Economics
- Infectious Disease Epidemiology
Background:
- Hepatitis C (HCV) presents a significant public health challenge requiring intensified efforts for case identification.
- Primary care settings are crucial for implementing effective HCV case-finding strategies.
- Former injecting drug users (IDUs) are a key population for targeted HCV screening.
Purpose of the Study:
- To conduct a cost-utility analysis of systematic hepatitis C case finding within primary care settings.
- To specifically evaluate this strategy among a cohort of former injecting drug users (IDUs).
Main Methods:
- A Markov model simulated the impact of HCV case finding and treatment on disease progression in 1000 former IDUs.
- Compared systematic case finding with a control group allowing spontaneous testing.
- Utilized ELISA and PCR tests, with eligible patients receiving combination therapy (pegylated interferon and ribavirin).
Main Results:
- Cost utility was estimated at approximately £16,000 per QALY for both case-finding and spontaneous presentation scenarios.
- A 75% probability of cost-effectiveness was observed at a willingness-to-pay threshold of £30,000 per QALY.
- Uncertainties identified include utility data, discounting, and spontaneous re-presentation rates.
Conclusions:
- HCV case finding in primary care is likely cost-effective, despite existing uncertainties.
- Further research is necessary to explore and refine various primary care-based case-finding approaches.
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