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J Hepatol. 2018 Oct;69(4):785-792. doi: 10.1016/j.jhep.2018.05.027. Epub 2018 Jul 1.

Assessing the cost-effectiveness of hepatitis C screening strategies in France.

Author information

1
IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Université Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France. Electronic address: sylvie.burban@inserm.fr.
2
IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
3
Santé publique France, Saint-Maurice, France.
4
Service Santé Publique, Hôpital Henri-Mondor, Créteil, France.
5
Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, Lille, France.
6
Université Lille, Inserm, CHU Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, Lille, France.
7
Inserm U955, Hôpital Henri-Mondor, Créteil, France.
8
IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de maladies Infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France.

Abstract

BACKGROUND & AIMS:

In Europe, hepatitis C virus (HCV) screening still targets people at high risk of infection. We aim to determine the cost-effectiveness of expanded HCV screening in France.

METHODS:

A Markov model simulated chronic hepatitis C (CHC) prevalence, incidence of events, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER) in the French general population, aged 18 to 80 years, undiagnosed for CHC for different strategies: S1 = current strategy targeting the at risk population; S2 = S1 and all men between 18 and 59 years; S3 = S1 and all individuals between 40 and 59 years; S4 = S1 and all individuals between 40 and 80 years; S5 = all individuals between 18 and 80 years (universal screening). Once CHC was diagnosed, treatment was initiated either to patients with fibrosis stage ≥F2 or regardless of fibrosis. Data were extracted from published literature, a national prevalence survey, and a previously published mathematical model. ICER were interpreted based on one or three times French GDP per capita (€32,800).

RESULTS:

Universal screening led to the lowest prevalence of CHC and incidence of events, regardless of treatment initiation. When considering treatment initiation to patients with fibrosis ≥F2, targeting all people aged 40-80 was the only cost-effective strategy at both thresholds (€26,100/QALY). When we considered treatment for all, although universal screening of all individuals aged 18-80 is associated with the highest costs, it is more effective than targeting all people aged 40-80, and cost-effective at both thresholds (€31,100/QALY).

CONCLUSIONS:

In France, universal screening is the most effective screening strategy for HCV. Universal screening is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of HCV eradication, this strategy should be implemented.

LAY SUMMARY:

In the context of highly effective and well tolerated therapies for hepatitis C virus that are now recommended for all patients, a reassessment of hepatitis C screening strategies is needed. An effectiveness and cost-effectiveness study of different strategies targeting either the at-risk population, specific ages or all individuals was performed. In France, universal screening is the most effective strategy and is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of hepatitis C virus eradication, this strategy should be implemented.

KEYWORDS:

Chronic hepatitis C; Cohort Markov model; Cost-effectiveness analysis; Effectiveness analysis; Interferon-free direct-acting antiviral agents; Screening

PMID:
30227916
DOI:
10.1016/j.jhep.2018.05.027

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