Age-Based vs. Risk-Based HCV Screening: What’s More Cost-Effective?

Birth cohort screening followed by an oral hepatitis C virus (HCV) treatment regimen is highly cost-effective in providing health and economic benefits, results from an analysis analysis showed at the American Association for the Study of Liver Diseases’ AASLD Liver Meeting, in Boston, MA.

Recommended screening for HCV has been risk-based until the Centers for Disease Control and Prevention (CDC) expanded it to those born between 1945–1965, known as the “baby boomers.”

Researchers aimed to determine the health and economic impact of a one-time screening for HCV during this period of highly effective HCV treatment regimens that are available. Four strategies for chronic hepatitis C (CHC) screening were compared by a decision analytic Markov model for people born 1945–1965 without known CHC: risk-based screening with treatment based stage of liver disease (RBS); risk-based screening and treat all without staging (RBA); birth cohort screening with treatment based on the stage of liver disease (BCSS); or birth cohort screening and treat all without staging (BCSA).

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An oral treatment regimen was assumed to have 98% sustained virologic response (SVR) with a cost of $1,000 daily for 12 weeks with no treatment discontinuation; however, those with CHC knowledge had a disutility value of 0.02. Efficacy was measured in quality-adjusted life years (QALYs) and disease progression.

Results from the analysis showed that of the 100 million people that would be screened, 1.4 million would have unknown CHC. Out of the 4 strategies compared, BCSA proved most cost-effective, with an incremental cost-effectiveness ratio (ICER) of $32,263/QALY. In addition, 22.9 million more QALYs were produced through the BCSA strategy while costing an extra $123 billion.

Study authors concluded that birth cohort screening of the baby boomers along with the availability of highly effective oral HCV treatment regimens was highly cost-effective and beneficial at the population level.

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