Cost-effectiveness of opportunistic age-based hepatitis C screening using pooled HCV RNA testing in Galicia, Spain

Targeted hepatitis C virus (HCV) screening, particularly in age groups with a higher prevalence of infection, may improve case detection and accelerate progress towards HCV elimination. This study evaluated the cost-effectiveness of opportunistic age-based HCV screening among individuals aged 50-60 years in Galicia, Spain, using a pooled HCV RNA testing strategy.

HCV RNA testing was performed using a previously validated sample-pooling strategy. A validated lifetime Markov model of chronic HCV infection was adapted to compare three scenarios: (1) pooling-based screening versus no intervention; (2) pooling-based screening versus standard testing, defined as anti-HCV antibody testing followed by HCV RNA confirmation; and (3) standard testing versus no intervention. The model incorporated Spanish epidemiological and clinical data, sustained virological response rates with direct-acting antivirals, and official healthcare costs. Analyses were conducted from the perspective of the Spanish National Health System, using a lifetime horizon and a 3% annual discount rate for costs and health outcomes.

Among 157,606 screened individuals, 221 were identified as HCV RNA positive. Compared with no intervention, pooling-based screening was projected to reduce the lifetime incidence of liver-related complications and mortality by 64%-72%. Although the strategy increased initial screening and diagnostic costs by €181,716, it generated savings of €2,328,496 in the management of liver-related complications and was therefore a dominant strategy, providing better health outcomes at a lower overall cost. Compared with standard testing, pooling-based screening achieved equivalent clinical outcomes but reduced costs by €663 per diagnosed viraemic patient. Standard testing was cost-effective compared with no intervention.

Opportunistic age-based HCV screening among individuals aged 50-60 years was dominant compared with no intervention. Pooled HCV RNA testing provides equivalent clinical effectiveness to standard testing at a lower cost per diagnosed viraemic patient and represents a scalable approach to support HCV elimination in low-prevalence settings.