Researchers at the University of Cincinnati have found that targeted screening for populations with a higher estimated prevalence for hepatitis C may be cost-effective. These findings, published online in Clinical Infectious Diseases, indicate that targeted screening for chronic hepatitis C virus infection is cost-effective when the prevalence of hepatitis C in a population exceeds 0.84% (84/10,000). The study further demonstrates how a screening tool, which can be incorporated into an electronic health record, can target such patients and help in preventing the spread of the illness.
The model explored strategies of screening followed by guideline-based treatment, if needed, and not screening. Effectiveness was measured in quality-adjusted life years (QALYs)—accounting for both duration of survival and quality of life. Mark Eckman, MD, Professor of Internal Medicine, professor in the division of general internal medicine, and UC Health physician, co-authored the study. “In the base case, screening followed by guideline-based treatment—using boceprevir as the standard antiviral treatment—of those with chronic hepatitis C infection cost roughly $47,000 per QALY—a “'cost-effective' result,” says Eckman. “The overall hepatitis C prevalence in the U.S. is reported to be between 1.3% and 1.9%, but prevalence varies among patients with different risk factors.”
Eckman notes that the marginal cost-effectiveness ratio (mCER) of screening decreases as prevalence increases. “Below a prevalence of 0.84% within a population, the mCER is greater than the generally accepted societal willingness-to-pay threshold of $50,000 per QALY,” he says. “Therefore, it is not considered highly cost-effective. However, by targeting screening in populations with a higher estimated prevalence, screening and subsequent treatment of those infected would be cost effective.” Read the study abstract.