Background: Cost-effective screening strategies are needed to make Hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost-effective in Italy, a high endemic country. Methods: An economic impact model was developed to quantify medical costs and health effects associated with HCV, denominated in quality-adjusted life years (QALYs). The model-estimated prevalence of undiagnosed HCV was used to calculate the number of antibody screens needed annually, with a €25,000 cost-effectiveness threshold. Outcomes over 2018–31 were assessed under the status quo and a scenario that met the World Health Organization’s targets for elimination of HCV. The elimination scenario was assessed under five screening strategies, including universal screening and birth cohort screening. Results: A graduated birth cohort strategy (screening 1968–48 birth cohorts first before expanding to 1968– 88 cohorts) was the least costly. This strategy would gain 143,929 QALYs by 2031 and result in an 89.3% reduction in HCV cases, compared to an 89.6%, 89.0%, 89.7%, and 88.7% reduction for inversed graduated screening, 1948–77 birth cohort, 1958–77 birth cohort, and universal screening, respectively. Graduated screening 1 yielded the lowest incremental cost effectiveness ratio (ICER) of €3,552 per QALY. Conclusion: In Italy, a graduated screening scenario is the most cost-effective strategy. Other countries could consider this approach when developing screening strategies based on specific HCV epidemiology.
Optimization of Hepatitis C Virus screening strategies by birth cohort in Italy
Luchino Chessa
2019-01-01
Abstract
Background: Cost-effective screening strategies are needed to make Hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost-effective in Italy, a high endemic country. Methods: An economic impact model was developed to quantify medical costs and health effects associated with HCV, denominated in quality-adjusted life years (QALYs). The model-estimated prevalence of undiagnosed HCV was used to calculate the number of antibody screens needed annually, with a €25,000 cost-effectiveness threshold. Outcomes over 2018–31 were assessed under the status quo and a scenario that met the World Health Organization’s targets for elimination of HCV. The elimination scenario was assessed under five screening strategies, including universal screening and birth cohort screening. Results: A graduated birth cohort strategy (screening 1968–48 birth cohorts first before expanding to 1968– 88 cohorts) was the least costly. This strategy would gain 143,929 QALYs by 2031 and result in an 89.3% reduction in HCV cases, compared to an 89.6%, 89.0%, 89.7%, and 88.7% reduction for inversed graduated screening, 1948–77 birth cohort, 1958–77 birth cohort, and universal screening, respectively. Graduated screening 1 yielded the lowest incremental cost effectiveness ratio (ICER) of €3,552 per QALY. Conclusion: In Italy, a graduated screening scenario is the most cost-effective strategy. Other countries could consider this approach when developing screening strategies based on specific HCV epidemiology.
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