The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings

Ann Intern Med. 2012 Feb 21;156(4):263-70. doi: 10.7326/0003-4819-156-4-201202210-00378. Epub 2011 Nov 4.

Abstract

Background: In the United States, hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and approximately 50% to 75% of infected adults are unaware of their infection.

Objective: To estimate the cost-effectiveness of birth-cohort screening.

Design: Cost-effectiveness simulation.

Data sources: National Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, and published sources.

Target population: Adults born from 1945 through 1965 with 1 or more visits to a primary care provider annually.

Time horizon: Lifetime.

Perspective: Societal, health care.

Intervention: One-time antibody test of 1945-1965 birth cohort.

Outcome measures: Numbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted life-years (QALYs); incremental cost-effectiveness ratio (ICER).

Results of base-case analysis: Compared with the status quo, birth-cohort screening identified 808,580 additional cases of chronic HCV infection at a screening cost of $2874 per case identified. Assuming that birth-cohort screening was followed by pegylated interferon and ribavirin (PEG-IFN+R) for treated patients, screening increased QALYs by 348,800 and costs by $5.5 billion, for an ICER of $15,700 per QALY gained. Assuming that birth-cohort screening was followed by direct-acting antiviral plus PEG-IFN+R treatment for treated patients, screening increased QALYs by 532,200 and costs by $19.0 billion, for an ICER of $35,700 per QALY saved.

Results of sensitivity analysis: The ICER of birth-cohort screening was most sensitive to sustained viral response of antiviral therapy, the cost of therapy, the discount rate, and the QALY losses assigned to disease states.

Limitation: Empirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce.

Conclusion: Birth-cohort screening for HCV in primary care settings was cost-effective.

Primary funding source: Division of Viral Hepatitis, Centers for Disease Control and Prevention.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Antiviral Agents / therapeutic use
  • Cohort Studies
  • Computer Simulation
  • Contraindications
  • Cost-Benefit Analysis
  • Hepatitis C Antibodies / blood*
  • Hepatitis C, Chronic / diagnosis*
  • Hepatitis C, Chronic / drug therapy
  • Hepatitis C, Chronic / mortality
  • Humans
  • Interferon-alpha / therapeutic use
  • Markov Chains
  • Mass Screening / economics*
  • Middle Aged
  • Primary Health Care / economics*
  • Quality-Adjusted Life Years
  • Ribavirin / therapeutic use
  • Sensitivity and Specificity
  • United States / epidemiology

Substances

  • Antiviral Agents
  • Hepatitis C Antibodies
  • Interferon-alpha
  • Ribavirin