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Screening general population for hepatitis C appears cost-effective

Issue: May 2012

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Screening the general population for hepatitis C virus appeared to be cost-effective, but reducing morbidity and mortality requires higher rates of referral, treatment and cure, according to researchers from the University of Washington.

“More than 4 million US residents have been infected with hepatitis C virus, between 2.9 and 3.7 million have chronic hepatitis C and 49% to 75% of infected persons are unaware of their infection,” the researchers wrote. “Despite the scale of the problem and the availability of increasingly effective therapy, national guidelines established when treatment was less efficacious to recommend testing only to persons with identified risk factors.”

The researchers developed a decision analytic model for screening intervention and a Markov model that defined the natural history, costs and quality-adjusted life years (QALYs) of chronic hepatitis C. They also conducted subanalyses that included protease inhibitor therapy and screening those at highest risk for infection (birth year 1945-1965).

The incremental cost per QALY gained was $7,900 for general population screening and $4,200 for screening only by birth year. In sensitivity analyses, the incremental cost per QALY of screening the general population remained less than $50,000, as long as hepatitis C virus seropositivity in the tested population remained more than 0.53%. Approximately 1% of liver-related death would be averted per 15% of the general population screened. This would be greater with improved referral, treatment and cure.

“Similar to recent experience with HIV, broadened screening is only the first step in a comprehensive public health effort,” the researchers wrote. “Successfully limiting hepatitis C virus-associated morbidity and mortality will require initiatives to identify infected persons and ensure their treatment.”

References:

• Coffin PO. Clin Infect Dis. 2012;54:1259-1271.

Disclosures:

• One of the researchers reports receiving grants, consulting fees or travel support from Anadys, Genentech, GenProbe, Gilead, Merck, Vertex and Tibotec, and another researcher reports receiving free test kits from GenProbe.