Cost-effectiveness of screening for chronic hepatitis C infection in the United States

Mark H. Eckman, Andrew H. Talal, Stuart C. Gordon, Eugene R Schiff, Kenneth E. Sherman

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background. Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the United States and will become an increasing source of morbidity and mortality with aging of the infected population. Our objective was to develop decision analytic models to explore the cost-effectiveness of screening in populations with varying prevalence of HCV and risks for fibrosis progression.Methods. We developed a Markov state transition model to examine screening of an asymptomatic community-based population in the United States. The base case was an ethnically and gender-mixed adult population with no prior knowledge of HCV status. Interventions were screening followed by guideline-based treatment, or no screening. Effectiveness was measured in quality-adjusted life-years (QALYs), and costs were measured in 2011 US dollars.Results. In the base case (US population, 49% male, 78% white, 13% African American, and 9% Hispanic, mean age, 46 years), screening followed by guideline-based treatment (using boceprevir as the direct-acting antiviral agent) of those with chronic HCV infection costs $47 276 per QALY. The overall HCV prevalence in the United States is reported to be 1.3%-1.9%, but prevalence varies markedly among patients with different numbers and types of risk factors. The marginal cost-effectiveness ratio (mCER) of screening decreases as prevalence increases. Below a prevalence of 0.84%, the mCER is greater than the generally accepted societal willingness-to-pay threshold of $50 000 per QALY and thus is not considered highly cost-effective. Conclusions. Targeted screening is cost-effective when prevalence of HCV exceeds 0.84%. Prospective evaluation of a screening tool is warranted and should include comparisons with other screening strategies.

Original languageEnglish
Pages (from-to)1382-1393
Number of pages12
JournalClinical Infectious Diseases
Volume56
Issue number10
DOIs
StatePublished - May 15 2013

Fingerprint

Chronic Hepatitis C
Hepacivirus
Cost-Benefit Analysis
Quality-Adjusted Life Years
Infection
Costs and Cost Analysis
Population
Guidelines
Virus Diseases
Hispanic Americans
African Americans
Antiviral Agents
Fibrosis
Morbidity
Mortality
Therapeutics

Keywords

  • cost-effectiveness analysis
  • decision analysis
  • hepatitis C
  • screening

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

Cite this

Cost-effectiveness of screening for chronic hepatitis C infection in the United States. / Eckman, Mark H.; Talal, Andrew H.; Gordon, Stuart C.; Schiff, Eugene R; Sherman, Kenneth E.

In: Clinical Infectious Diseases, Vol. 56, No. 10, 15.05.2013, p. 1382-1393.

Research output: Contribution to journalArticle

Eckman, Mark H. ; Talal, Andrew H. ; Gordon, Stuart C. ; Schiff, Eugene R ; Sherman, Kenneth E. / Cost-effectiveness of screening for chronic hepatitis C infection in the United States. In: Clinical Infectious Diseases. 2013 ; Vol. 56, No. 10. pp. 1382-1393.
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abstract = "Background. Hepatitis C virus (HCV) is the most common chronic blood-borne infection in the United States and will become an increasing source of morbidity and mortality with aging of the infected population. Our objective was to develop decision analytic models to explore the cost-effectiveness of screening in populations with varying prevalence of HCV and risks for fibrosis progression.Methods. We developed a Markov state transition model to examine screening of an asymptomatic community-based population in the United States. The base case was an ethnically and gender-mixed adult population with no prior knowledge of HCV status. Interventions were screening followed by guideline-based treatment, or no screening. Effectiveness was measured in quality-adjusted life-years (QALYs), and costs were measured in 2011 US dollars.Results. In the base case (US population, 49{\%} male, 78{\%} white, 13{\%} African American, and 9{\%} Hispanic, mean age, 46 years), screening followed by guideline-based treatment (using boceprevir as the direct-acting antiviral agent) of those with chronic HCV infection costs $47 276 per QALY. The overall HCV prevalence in the United States is reported to be 1.3{\%}-1.9{\%}, but prevalence varies markedly among patients with different numbers and types of risk factors. The marginal cost-effectiveness ratio (mCER) of screening decreases as prevalence increases. Below a prevalence of 0.84{\%}, the mCER is greater than the generally accepted societal willingness-to-pay threshold of $50 000 per QALY and thus is not considered highly cost-effective. Conclusions. Targeted screening is cost-effective when prevalence of HCV exceeds 0.84{\%}. Prospective evaluation of a screening tool is warranted and should include comparisons with other screening strategies.",
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