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Optimization of Hepatitis C Virus Screening Strategies by Birth Cohort in Italy

31 Pages Posted: 13 Aug 2019

See all articles by Loreta Kondili

Loreta Kondili

Istituto Superiore di Sanità - Center for Global Health

Ivane Gamkrelidze

Center for Disease Analysis Foundation

Sarah Blach

Center for Disease Analysis Foundation

Andrea Marcellusi

University of Rome Tor Vergata

Massimo Galli

University of Milan

Salvatore Petta

University of Palermo

Massimo Pouti

Istituto Superiore di Sanità

Stefano Vella

Istituto Superiore di Sanità - Center for Global Health

Homie Razavi

Center for Disease Analysis Foundation

Antonio Craxì

University of Palermo

Francesco Mennini

University of Rome Tor Vergata - Centre for International Studies on Economic Growth (CEIS); Kingston University - School of Accounting and Finance

PITER Collaborating Group

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Abstract

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 €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

Suggested Citation

Kondili, Loreta and Gamkrelidze, Ivane and Blach, Sarah and Marcellusi, Andrea and Galli, Massimo and Petta, Salvatore and Pouti, Massimo and Vella, Stefano and Razavi, Homie and Craxì, Antonio and Mennini, Francesco and Group, PITER Collaborating, Optimization of Hepatitis C Virus Screening Strategies by Birth Cohort in Italy (August 7, 2019). Available at SSRN: https://ssrn.com/abstract=3433898 or http://dx.doi.org/10.2139/ssrn.3433898

Loreta Kondili (Contact Author)

Istituto Superiore di Sanità - Center for Global Health ( email )

Italy

Ivane Gamkrelidze

Center for Disease Analysis Foundation

United States

Sarah Blach

Center for Disease Analysis Foundation

United States

Andrea Marcellusi

University of Rome Tor Vergata

Via di Tor Vergata
Rome, Lazio 00133
Italy

Massimo Galli

University of Milan

Via Festa del Perdono, 7
Milan, 20122
Italy

Salvatore Petta

University of Palermo

Viale delle Scienza
Palermo, 90128
Italy

Massimo Pouti

Istituto Superiore di Sanità

Viale Regina Elena 299
Roma, 00161
Italy

Stefano Vella

Istituto Superiore di Sanità - Center for Global Health

Italy

Homie Razavi

Center for Disease Analysis Foundation

United States

Antonio Craxì

University of Palermo ( email )

Viale delle Scienza
Palermo, 90128
Italy

Francesco Mennini

University of Rome Tor Vergata - Centre for International Studies on Economic Growth (CEIS) ( email )

Via Columbia, 2
Rome, I-00133
Italy

Kingston University - School of Accounting and Finance ( email )

United Kingdom

No contact information is available for PITER Collaborating Group

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