Cost-Effectiveness of the National Screening Program for Hepatitis C Virus in the General Population and the High-Risk Groups

Abstract

In Japan, the national screening for the hepatitis C virus (HCV) has been started for both the general population and the high-risk groups. Our cost-effectiveness analysis was based on the result of the screening program including 99,001 people among the general population and 42,538 people among the high risk group from 2003 to 2006. The screening was performed using the three steps of the semi-quantitative HCV antibody test, the HCV core antigen test and the HCV-PCR test. A Markov model for HCV infected patients was constructed to estimate the future clinical benefits and the lifetime cost and the cost-effectiveness analysis was performed considering the recent treatment with peginterferon plus ribavirin. In the cost-effectiveness analysis, the cohort, in which the screening was implemented (= screening strategy), was compared with the similar cohort without the screening (= no-screening strategy) in both the general population and the high-risk group, stratified by age. The infection rates of the general population and the high-risk group were 0.36% and 0.81%, respectively. The incremental cost-effectiveness ratio (ICER), a measure of cost-effectiveness, of the general population and the high-risk group was calculated to be from 848 to 4,825 and -749 to 2,297 $/life expectancy gained, respectively. The treatment effectiveness, transition probabilities and the infection rate varied in the one-way sensitivity analyses, but the superiority of the screening strategy regarding the cost-effectiveness was unchanged. In conclusion, the screening strategy in both the general population and the high-risk group therefore appears to be more cost-effective than a no-screening strategy.screening; hepatitis C; general population; high risk group; cost-effectiveness. Tohoku

Cost-Outcome Description of PEG-IFN-α2b+RBV for Hepatitis C: Results Based on the Interferon Database

“…Utilities are described by Quality Adjusted Life Year (QALY). QALYs and transition probabilities are similar to previous HCV treatment economic evaluation studies in Japan [15][16][17][18][19][20][21][22] (Tables 1, 2). The simulation was performed using the Tree Age Pro Healthcare 2016 v2.1 (Tree Age Software, Inc., Williamstown, MA, U.S.A.) for a period of 10 years with no discount rate.…”

“…The simulation was performed using the Tree Age Pro Healthcare 2016 v2.1 (Tree Age Software, Inc., Williamstown, MA, U.S.A.) for a period of 10 years with no discount rate. 15) CH to HCC 0.016 Nakamura et al 15) comp-LC to decomp-LC 0.021 Imazeki et al 16) comp-LC to HCC 0.043 Hayashida et al 17) decomp-LC to HCC 0.083 Nakamura et al 15) decomp-LC to death 0.153 Nakamura et al 15) HCC to death 0.200 Nakamura et al 15) comp-LC SVR to HCC 0.018 Arase et al 18) CH/comp-LC to SVR 0.080 Broglio et al 19) …”

“…McEwan et al 13) decomp-LC 1561085 McEwan et al 13) 0.670 Okita 22) HCC 2086469 Nakamura et al 15) 0.380 Ishida et al…”

Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study

“…It is hard to ignore a level this high, and the wide confidence levels from our data suggest the need for flexibility. 116 2. The progression for undetected chronic viral hepatitis is worse for patients with ALT levels that are greater than twice the ULN, and this level has been used as a threshold for treatment in guidelines.…”

988 Outcomes of Hepatitis C Screening Programs Targeted at Risk Groups Hidden in the General Population: A Systematic Review

“…Furthermore, as identification of HCV-infected individuals serves a clinical goal and not necessarily a scientific goal, not all screening efforts have been evaluated or published. Our search identified several announcements of HCV screening activities [103,104] or cost-effectiveness evaluations of screening activities [105] that did not provide any further information about the screening program and/or outcomes. Further, our review describes several screening programs, but it cannot determine the efficiency and effectiveness of these screening programs in preventing future HCV-related morbidity and mortality.…”