Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis

Area of Science:

• Hepatology
• Public Health
• Health Economics

Background:

• Current hepatitis C (HCV) screening in Russia is a multi-step process with low adherence and reduced identification of active infections.
• The existing stepwise testing pathway limits patient compliance and diagnostic yield.
• Evaluating cost-effectiveness of alternative screening algorithms is crucial for improving public health outcomes.

Purpose of the Study:

• To assess the cost-effectiveness of different hepatitis C screening algorithms from a health system perspective in Russia.
• To compare the standard antibody screening followed by RNA testing with novel strategies incorporating antigen testing.
• To identify the most efficient strategy for diagnosing active HCV infections in a general adult population.

Main Methods:

• A decision analytic model simulated a hypothetical Russian adult population undergoing HCV screening.
• Four strategies were compared: standard (antibody then RNA), and three alternatives involving reflex HCV antigen testing.
• Effectiveness was measured by diagnosed active infections; costs were based on 2017 reimbursement rates with a willingness-to-pay threshold.

Main Results:

• Alternative strategies (II, III, IV) identified 67-104% more infections than the standard pathway (I), which had a reduced capture rate (40.6%) due to non-adherence.
• Average costs per diagnosed infection decreased by 41% with alternative strategies, ranging from 53,004 to 59,633 RUB.
• Strategy III (antibody, reflex antigen, RNA on antigen negatives) was most cost-effective with 97% probability, showing an incremental cost-effectiveness ratio of -1,373 RUB versus Strategy I.

Conclusions:

• Incorporating HCV antigen testing alongside antibody screening streamlines hepatitis C detection in Russian population screening programs.
• These optimized strategies enhance the identification of active infections and offer significant cost-effectiveness improvements over current practices.
• Strategy III presents a highly cost-effective approach for improving hepatitis C diagnosis rates in Russia.