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Am J Med. 2001 Dec 1;111(8):614-21.

Cost effectiveness of screening for hepatitis C virus in asymptomatic, average-risk adults.

Author information

1
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

Abstract

PURPOSE:

To estimate the cost effectiveness of screening for hepatitis C in asymptomatic, average-risk adults.

METHODS:

We used a Markov decision analysis model to estimate the lifetime cost effectiveness of three screening strategies: (1) initial screening for hepatitis C antibody by third-generation enzyme-linked immunosorbent assay (ELISA), followed by confirmatory testing for hepatitis C virus ribonucleic acid (RNA) using polymerase chain reaction (PCR); (2) initial screening for hepatitis C virus RNA by PCR only; and (3) the current practice of not screening. The patient population comprised a hypothetical cohort of average-risk adults presenting to their regular primary health care provider for routine physical examination. The main outcome measure was cost per additional quality-adjusted life-year (QALY) gained.

RESULTS:

The no screening strategy was the dominant strategy in the baseline analysis. The model was most sensitive to the reduction in quality of life related to patient awareness of hepatitis C infection. Screening with ELISA and PCR was preferred when this value was <0.01 and was cost effective if more than half of the patients who tested positive for hepatitis C actually initiated treatment, or if the annual rate of progression to cirrhosis was greater than 2.5%. Screening with PCR only was never cost effective.

CONCLUSIONS:

This analysis does not support the widespread screening for hepatitis C among asymptomatic, average-risk adults.

PMID:
11755504
[Indexed for MEDLINE]

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