Hepatitis C virus infection screening reduces mortality and is cost-effective independently of the intervention test

ABSTRACT

Introduction: chronic infection due to hepatitis C virus (HCV)is frequently asymptomatic even in advanced stages of liverdisease. Implementation of a screening program based ondifferent HCV tests may enable an earlier diagnosis of HCVliver disease and subsequent application of highly effectivetreatment.Patients and methods: a Markov model which comparesthree different screening strategies for hepatitis C versus noscreening in low-risk prevalence (general population) andhigh-risk prevalence population (people who inject drugs orprison population) was designed, taking into account age atthe start of screening and participation. The three strategieswere a) serological detection of antibodies against the HCV;b) dried blood spot test (DBS) to detect antibodies againstHCV; and c) detection of ribonucleic acid (RNA) from HCV.Quality-adjusted life-years (QALY) were taken as a measurement of effectiveness. The incremental cost-effectivenessratio (ICER) was calculated and a deterministic and probabilistic sensitivity analysis was performed.Results: all three screening strategies were found to becost-effective, with an ICER of €13,633, €12,015 and €12,328/QALY for antiHCV, DBS-antiHCV and DBS-RNA HCV, respectively. There was a decrease in mortality due to liver disease in comparison to no screening for antiHCV (40.7 % and52 %), DBS-antiHCV (45 % and 80 %) and DBS-RNA HCV (45.2 % and 80 %) for low-prevalence and high-prevalencepopulations, respectively.Conclusion: all test interventions for HCV screening arecost-effective for the early detection of HCV infection, alsoachieving a reduction in mortality. Thus, implementationof screening programs for HCV should not be halted by decisions on monetary policy. (AU)