Optimization of Hepatitis C Virus Screening Strategies by Birth Cohort in Italy
31 Pages Posted: 13 Aug 2019More...
Background: Cost-effective screening strategies are needed to make Hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost-effective in Italy, an HCV high endemic country.
Methods: An economic impact model was developed to quantify medical costs and health effects associated with HCV, denominated in quality-adjusted life years (QALYs). The model-estimated prevalence of undiagnosed HCV was used to calculate the antibody screens needed annually, with a â‚¬25,000 cost-effectiveness threshold. Outcomes over 2018-31 were assessed under the status quo and a scenario that met the World Health Organization's targets for elimination of HCV. The elimination scenario was assessed under five screening strategies, including universal screening and birth cohort screening.
Findings: A graduated birth cohort strategy (screening 1: 1968-1987 birth cohorts first before expanding to 1948-1967 cohorts) was the least costly. This strategy would gain 143,929 QALYs by 2031 and result in an 89·3% reduction in HCV cases, compared to an 89·6%, 89·0%, 89·7%, and 88·7% reduction for inversed graduated screening, 1948-77 birth cohort, 1958-77 birth cohort, and universal screening, respectively. Graduated screening 1 yielded the lowest incremental cost effectiveness ratio (ICER) of €3,552 per QALY gained.
Interpretation: In Italy, a graduated screening scenario is the most cost-effective strategy. Other countries could consider this approach when developing HCV epidemiological-specific screening strategies.
Funding Statement: This study was supported by the Italian Ministry of Health, grant number RF-2016-02364053 and by a research grant from Tor Vergata University of Rome, Italy.
Declaration of Interests: The authors declare no conflict of interest.
Ethics Approval Statement: Not required.
Keywords: cost-effectiveness, HCV, screening, WHO Targets
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