Source OptumInsight, Medford, MA. firstname.lastname@example.org.
Recent research has identified high hepatitis C virus (HCV) prevalence among older US residents who contracted HCV decades ago and may no longer be recognized as high-risk. We assessed the cost-effectiveness of screening 100% of US residents born 1946-1970 over 5 years (birth-cohort screening) compared with current risk-based screening, by projecting costs and outcomes of screening over the remaining lifetime of this birth cohort. A Markov model of the natural history of HCV was developed using data synthesized from surveillance data, published literature, expert opinion, and other secondary sources.
We assumed eligible patients were treated with pegylated interferon plus ribavirin, with genotype 1 patients receiving a direct-acting antiviral in combination. The target population is US residents born 1946-1970 with no prior HCV diagnosis. Among the estimated 102 million (1.6 million chronically HCV-infected) eligible for screening, birth-cohort screening leads to 84,000 fewer cases of decompensated cirrhosis, 46,000 fewer cases of hepatocellular carcinoma, 10,000 fewer liver transplants and 78,000 fewer HCV-related deaths. Birth-cohort screening led to higher overall costs than risk-based screening ($80.4 billion vs. $53.7 billion), but yielded lower costs related to advanced liver disease ($31.2 billion vs. $39.8 billion); birth-cohort screening produced an incremental cost-effectiveness ratio (ICER) of $37,700 per quality-adjusted life-year gained versus risk-based screening. Sensitivity analyses showed that reducing the time horizon during which health and economic consequences are evaluated increases the ICER, whereas decreasing the treatment rates and efficacy increases the ICER. Model results were relatively insensitive to other inputs.
CONCLUSION: Birth-cohort screening for HCV is likely to provide important health benefits by reducing lifetime cases of advanced liver disease and HCV-related deaths, and is cost-effective at conventional willingness-to-pay thresholds.