Cost Effectiveness of Screening for Hepatitis C Virus in Iraq in the Era of Simplified Testing and Treatment

Abstract

Background and Objective Recent advances in hepatitis C virus (HCV) diagnostic testing methods allow for a one-stop simplified ‘test and cure’ approach. The cost effectiveness of incorporating this simplified approach into HCV screening in Iraq remains uncertain. This study aimed to compare the cost effectiveness of different HCV testing and diagnostic approaches, and screening strategies in Iraq from a health service perspective. Methods A cost-effectiveness analysis was undertaken using a hybrid model comprising a screening decision tree linked to a lifetime Markov model to estimate outcomes in HCV-infected people. Cost and utility estimates were sourced from the published literature and expert guidance provided by clinicians and policy makers in Iraq. Cost estimates were reported in 2019 USD or 2019 Iraqi Dinar and both costs and benefits were discounted at 3.5% annually. Results Strategies using a simplified approach were found to be cost saving in addition to improving patient outcomes when compared with a standard testing and diagnostic approach. When considering risk-based screening, a simplified approach was associated with a total cost saving of Iraqi Dinar 4375 billion (USD 3.7 billion) and per patient life-year and quality-adjusted life-year gains of 0.30 and 0.55, compared with a standard approach. Benefits and cost savings were driven by a 32.2% and 23.6% reduction in the incidence of cirrhosis and hepatocellular carcinoma, respectively. Estimated benefits and cost savings increased under total population screening. All screening and testing and diagnostic approaches were cost effective compared with a no screening scenario. Conclusions Improvements in the detection of HCV combined with a simplified one-stop testing and diagnostic approach represents an opportunity to reduce the burden of HCV in Iraq and may play a significant role in meeting World Health Organisation HCV elimination targets. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-021-01064-z.

Impact of a Simplified Care Model on Direct-acting Antiviral Treatment for Hepatitis C Virus-positive People in Addiction Care: A Retrospective Review of the trueNorth Medical Centres Database

“…This model is aligned with the need to have a decentralized and simplified approach for the diagnosis of HCV and linkage to care 13,15,19,20,40 in PWUD and confirming the positive approach of integrating HCV care and substance use services 18 . Future research could include measuring the impact of such a simplified care model on people’s quality of life as well as a potential reduction in health utilities 41 . To improve the care model, on-site diagnostics for determining PTW12 viral load and peer-led models could be explored.…”

“…18 Future research could include measuring the impact of such a simplified care model on people's quality of life as well as a potential reduction in health utilities. 41 To improve the care model, on-site diagnostics for determining PTW12 viral load and peer-led models could be explored.…”