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The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings.

Rein DB, et al. Ann Intern Med. 2012.


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.


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.


22056542 [PubMed - indexed for MEDLINE]

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