Hepatitis C virus infection screening reduces mortality and is cost-effective independently of the intervention test

Abstract

Introduction: chronic infection due to hepatitis C virus (HCV) is frequently asymptomatic even in advanced stages of liver disease. Implementation of a screening program based on different HCV tests may enable an earlier diagnosis of HCV liver disease and subsequent application of highly effective treatment. Patients and methods: a Markov model which compares three different screening strategies for hepatitis C versus no screening in low-risk prevalence (general population) and high-risk prevalence population (people who inject drugs or prison population) was designed, taking into account age at the start of screening and participation. The three strategies were: a) serological detection of antibodies against the HCV; b) dried blood spot test (DBS) to detect antibodies against HCV; and c) detection of ribonucleic acid (RNA) from HCV. Quality-adjusted life-years (QALY) were taken as a measurement of effectiveness. The incremental cost-effectiveness ratio (ICER) was calculated and a deterministic and probabilistic sensitivity analysis was performed. Results: all three screening strategies were found to be cost-effective, with an ICER of €13,633, €12,015 and €12,328/QALY for antiHCV, DBS-antiHCV and DBS-RNA HCV, respectively. There was a decrease in mortality due to liver disease in comparison to no screening for antiHCV (40.7 % and 52 %), DBS-antiHCV (45 % and 80 %) and DBS-RNA HCV (45.2 % and 80 %) for low-prevalence and high-prevalence populations, respectively. Conclusion: all test interventions for HCV screening are cost-effective for the early detection of HCV infection, also achieving a reduction in mortality. Thus, implementation of screening programs for HCV should not be halted by decisions on monetary policy.