Abstract

BACKGROUND:

In the United States, hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and approximately 50% to 75% of infected adults are unaware of their infection.

OBJECTIVE:

To estimate the cost-effectiveness of birth-cohort screening.

DESIGN:

Cost-effectiveness simulation.

DATA SOURCES:

National Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, and published sources.

TARGET POPULATION:

Adults born from 1945 through 1965 with 1 or more visits to a primary care provider annually.

TIME HORIZON:

Lifetime.

PERSPECTIVE:

Societal, health care.

INTERVENTION:

One-time antibody test of 1945-1965 birth cohort.

OUTCOME MEASURES:

Numbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted life-years (QALYs); incremental cost-effectiveness ratio (ICER).

RESULTS OF BASE-CASE ANALYSIS:

Compared with the status quo, birth-cohort screening identified 808,580 additional cases of chronic HCV infection at a screening cost of $2874 per case identified. Assuming that birth-cohort screening was followed by pegylated interferon and ribavirin (PEG-IFN+R) for treated patients, screening increased QALYs by 348,800 and costs by $5.5 billion, for an ICER of $15,700 per QALY gained. Assuming that birth-cohort screening was followed by direct-acting antiviral plus PEG-IFN+R treatment for treated patients, screening increased QALYs by 532,200 and costs by $19.0 billion, for an ICER of $35,700 per QALY saved.

RESULTS OF SENSITIVITY ANALYSIS:

The ICER of birth-cohort screening was most sensitive to sustained viral response of antiviral therapy, the cost of therapy, the discount rate, and the QALY losses assigned to disease states.

LIMITATION:

Empirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce.

CONCLUSION:

Birth-cohort screening for HCV in primary care settings was cost-effective.

PRIMARY FUNDING SOURCE:

Division of Viral Hepatitis, Centers for Disease Control and Prevention.