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Cost-effectiveness of screening for chronic hepatitis C infection in the United States
Mark H Eckman1, Andrew H Talal, Stuart C Gordon
1Division of General Internal Medicine and the Center for Clinical Effectiveness, OH, USA. mark.eckman@uc.edu
Insights
Targeted Hepatitis C virus (HCV) screening is cost-effective when prevalence is over 0.84%. This approach identifies infections early, improving health outcomes for aging populations.
Area of Science:
- Hepatology and Infectious Diseases
- Health Economics and Outcomes Research
- Public Health and Epidemiology
Background:
- Hepatitis C virus (HCV) infection is a growing public health concern in the U.S. due to the aging infected population.
- HCV poses increasing risks for morbidity and mortality.
- Understanding the cost-effectiveness of screening is crucial for resource allocation.
Purpose of the Study:
- To develop decision analytic models for evaluating HCV screening cost-effectiveness.
- To analyze screening costs across populations with varying HCV prevalence and fibrosis progression risks.
Main Methods:
- A Markov state transition model was employed to simulate screening interventions in an asymptomatic U.S. community population.
- The model compared screening followed by treatment versus no screening.
- Effectiveness was measured in Quality-Adjusted Life-Years (QALYs), and costs were in 2011 U.S. dollars.
Main Results:
- Screening and treatment cost $47,276 per QALY in the base case U.S. population.
- Cost-effectiveness improves with higher HCV prevalence.
- Screening is not considered highly cost-effective if prevalence falls below 0.84%.
Conclusions:
- Targeted Hepatitis C virus (HCV) screening demonstrates cost-effectiveness when prevalence surpasses 0.84%.
- Further research is needed to prospectively evaluate screening tools and compare different screening strategies.
Background:
Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the United States and will become an increasing source of morbidity and mortality with aging of the infected population. Our objective was to develop decision analytic models to explore the cost-effectiveness of screening in populations with varying prevalence of HCV and risks for fibrosis progression.
Methods:
We developed a Markov state transition model to examine screening of an asymptomatic community-based population in the United States. The base case was an ethnically and gender-mixed adult population with no prior knowledge of HCV status. Interventions were screening followed by guideline-based treatment, or no screening. Effectiveness was measured in quality-adjusted life-years (QALYs), and costs were measured in 2011 US dollars.
Results:
In the base case (US population, 49% male, 78% white, 13% African American, and 9% Hispanic, mean age, 46 years), screening followed by guideline-based treatment (using boceprevir as the direct-acting antiviral agent) of those with chronic HCV infection costs $47 276 per QALY. The overall HCV prevalence in the United States is reported to be 1.3%-1.9%, but prevalence varies markedly among patients with different numbers and types of risk factors. The marginal cost-effectiveness ratio (mCER) of screening decreases as prevalence increases. Below a prevalence of 0.84%, the mCER is greater than the generally accepted societal willingness-to-pay threshold of $50 000 per QALY and thus is not considered highly cost-effective.
Conclusions:
Targeted screening is cost-effective when prevalence of HCV exceeds 0.84%. Prospective evaluation of a screening tool is warranted and should include comparisons with other screening strategies.
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