Cost-effectiveness of Hepatitis C virus self-testing in four settings

Area of Science:

• Public Health
• Infectious Diseases
• Health Economics

Background:

• Chronic hepatitis C virus (HCV) infection affects 58 million globally, with only 20% diagnosed.
• Hepatitis C virus self-testing (HCVST) offers a strategy to reach undiagnosed populations and improve HCV testing uptake.
• Economic evaluation is crucial for understanding the cost-effectiveness of implementing HCVST in diverse settings.

Purpose of the Study:

• To compare the cost per viraemic diagnosis or cure for HCVST versus traditional facility-based testing services.
• To analyze the economic impact of introducing HCVST across various high-risk populations in China, Georgia, Viet Nam, and Kenya.
• To identify key drivers influencing the cost-effectiveness of HCVST implementation.

Main Methods:

• A decision analysis model with a one-year time horizon was employed.
• Model parameters were informed by existing HCV testing and treatment programs, HIV self-testing data, and expert opinions.
• Cost per diagnosis and cure were calculated for HCVST and facility-based testing scenarios, with sensitivity analyses performed.

Main Results:

• HCVST increased the number of individuals tested, diagnosed, and cured across all settings.
• The incremental cost per diagnosis with HCVST varied significantly by setting, ranging from $104 (Viet Nam) to $2,647 (China).
• The incremental cost per cure was lowest in Georgia ($1,418) and highest in China ($4,956), influenced by HCV antibody prevalence.

Conclusions:

• HCVST expands testing and diagnosis reach but incurs higher initial costs compared to facility-based services.
• The cost-effectiveness of HCVST is strongly dependent on the prevalence of HCV antibody in the target population.
• Optimizing HCVST strategies, such as using blood-based tests or direct nucleic acid testing, can improve cost-effectiveness.