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Cost-Effectiveness Analysis of Different Testing Strategies that Use Antibody Levels to Detect Chronic Hepatitis C in
Víctor Granados-García1, Ana M Contreras2, Carmen García-Peña3
1Unidad de Investigación Epidemiológica y en Servicios de Salud Área Envejecimiento, Instituto Mexicano del Seguro Social, Ciudad de México, México.
Insights
The IMSS-Mexico1 strategy is the most cost-effective for detecting hepatitis C virus (HCV) infection in blood donors, costing $5,000 USD per true positive case. Other strategies also show cost-effectiveness within specific willingness-to-pay ranges.
Area of Science:
- Public Health
- Infectious Disease Epidemiology
- Health Economics
Background:
- Hepatitis C virus (HCV) infection remains a significant public health concern.
- Accurate and cost-effective screening strategies are crucial for blood donor safety.
- Existing HCV testing protocols require evaluation for optimal resource allocation.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of seven distinct HCV testing strategies for blood donors.
- To compare strategies based on Mexican and US guidelines.
- To identify the most economically viable approach for identifying chronic HCV infections.
Main Methods:
- A cost-effectiveness analysis was performed on seven HCV testing strategies.
- Strategies involved signal-to-cut-off (S/CO) ratio determination with reflex Immunoblot (IMB) or HCV RNA confirmation.
- Costs were analyzed from the perspective of the Mexican Institute of Social Security (IMSS) using a decision tree model.
Main Results:
- The IMSS-Mexico3 and IMSS-Mexico1 strategies outperformed CDC-based options in base-case analysis.
- IMSS-Mexico1 was the most cost-effective strategy at $5,000 USD per true positive (TP) case for a willingness-to-pay (WTP) up to $9,000 USD.
- IMSS-Mexico3, IMSS-Mexico2, and CDC-USA3 were also cost-effective, ranging from $7,800 to $8,800 USD per TP case.
Conclusions:
- HCV antibody testing strategies utilizing two or three S/CO ratio levels are cost-effective.
- These strategies efficiently identify individuals needing further reflex IMB or HCV RNA testing for chronic HCV confirmation.
- Optimized testing protocols can improve the detection of chronic HCV infections in blood donors.
Aim:
We conducted a cost-effectiveness analysis of seven hepatitis C virus (HCV) testing strategies in blood donors.
Methods:
Three of the seven strategies were based on HCV diagnosis and reporting guidelines in Mexico and four were from previous and current recommendations outlined by the CDC. The strategies that were evaluated determine antibody levels according to the signal-to-cut-off (S/CO) ratio and use reflex Immunoblot (IMB) or HCV RNA tests to confirm true positive (TP) cases of chronic HCV infection. Costs were calculated from the perspective of the Mexican Institute of Social Security (IMSS). A decision tree model was developed to estimate the expected number of true positive cases and costs for the base-case scenarios and for the sensitivity analyses.
Results:
Base-case findings indicate an extended dominance of the CDC-USA2 and CDC-USA4 options by the IMSS Mexico3 and IMSS-Mexico1 alternatives. The probabilistic sensitivity analyses results suggest that for a willingness-to-pay (WTP) range of $0-9,000 USD the IMSS-Mexico1 strategy is the most cost-effective of all strategies ($5,000 USD per TP). The IMSS-Mexico3, IMSS-Mexico2, and CDC-USA3 strategies are also cost-effective strategies that cost between $7,800 and $8,800 USD per TP case detected. The CDC-USA1 strategy was very expensive and not cost-effective.
Conclusions:
HCV antibody testing strategies based on the classification of two or three levels of the S/CO are cost-effective procedures to identify patients who require reflex IMB or HCV RNA testing to confirm chronic HCV infection.
