Hepatitis C Screening: A Health Technology Assessment.

Area of Science:

• Public Health
• Hepatology
• Health Technology Assessment

Background:

• Hepatitis C virus (HCV) infection can lead to severe liver disease, including cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
• Early detection through screening is crucial for linking infected individuals to care and treatment, preventing disease progression.
• Current screening relies on risk-based approaches, potentially missing asymptomatic cases.

Purpose of the Study:

• To assess the effectiveness and cost-effectiveness of one-time universal HCV screening for all adults and for the 1945-1975 birth cohort, compared to risk-based screening alone.
• To evaluate the budget impact of publicly funding expanded HCV screening programs in Ontario.
• To understand patient preferences and values regarding HCV screening.

Main Methods:

• Systematic literature search for clinical evidence and patient preferences.
• Risk of bias assessment using ROBINS-I and quality assessment using GRADE criteria.
• Cost-utility analysis from a public payer perspective and budget impact analysis for Ontario over 5 years.

Main Results:

• One-time universal HCV screening may identify more cases and link more individuals to care, though evidence quality is very low.
• Both universal screening strategies (all adults and 1945-1975 cohort) are less costly and more effective than risk-based screening alone.
• Cost-effectiveness is high, with 100% probability at willingness-to-pay thresholds of $50,000-$100,000 per QALY gained.

Conclusions:

• Expanded one-time HCV screening offers a more effective and cost-effective strategy than risk-based screening alone.
• Publicly funding universal screening in Ontario is projected to have significant budget implications over 5 years.
• Patient perspectives highlight the need to broaden screening beyond high-risk groups for earlier diagnosis and treatment.