Risk reduction, increased screening for HCV in MSM is cost saving, effective
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Compared to current practices of annual screening for hepatitis C virus in men who have sex with men, working toward reducing their risk and screening every 6 months could prove cost effective, according to a presentation.
“Risk reduction strategies are cost saving compared to current practices and this is especially when targeted to the high-risk groups and finally that the combination of risk reduction in the high-risk group and screening every 6 months has strong potential to be cost effective and this will depend on the decision maker willingness to pay,” Mathieu Castry, PhD, of the Université de Paris, said during his presentation at The Liver Meeting Digital Experience
Castry and colleagues stratified the population of MSM living with HIV into high- and low-risk, with high-risk defined as those who employ drugs for sex enhancement.
The researchers assigned a quality-of-life score with direct medical costs associated with HIV care, HCV screening and HCV disease care and defined risk reduction interventions based on annual educational counseling dispensed during hospital consultation with staff costs. They analyzed the impact of the 10 strategies on life years, quality-adjusted life years (QALYs), lifetime costs and incremental cost effectiveness ratios (ICERs) over a lifetime.
They then modeled 10 alternative screening and risk reduction strategies ranging from status quo of annual screening with no risk reduction measures (S1) to screening every 3 months with risk reduction strategies for both risk groups (S10).
Castry reported that all nine alternative strategies modestly increased life years and QALYs compared with current practices. Adding the risk reduction strategies for the high-risk group to the current practice of annual screening (S5) and adding the risk reduction strategy for both groups along with annual screening (S6) were both cost saving compared to standard of care.
“S5 and S6, which are basically risk reduction strategies while maintaining the yearly screening are actually cost saving compared to current practices ... because they are less costly and more effective,” Castry said.
Combining risk reduction strategy in the high-risk group with screening every 6 months (S7) produced the most effective ICER per QALY gained at 61,000 compared to S5, he said.
“We can say that the decision would have to be made between S5 and S7, which both include risk reduction for the high-risk group with S5 having yearly screening and S7 having screening every 6 months,” Castry said. “If the decision-maker is willing to pay between 60,000 and 200,000 per additional QALY, then they should choose strategy 7, which is screening every 6 months and risk reduction strategies.”