New data published in the Canadian Medical Association Journal suggest that screening all Canadians aged 25 to 64 years would be cost effective and save lives.
“The screening programs that we evaluated would identify people with chronic [hepatitis C virus] infection who are asymptomatic, which would in turn allow medical treatment to be offered, if needed, according to published guidelines, ideally before development of advanced liver disease,” William W.L. Wong, PhD, of the Toronto Health Economics and Technology Assessment Collaborative and the Leslie Dan Faculty of Pharmacy at the University of Toronto, and colleagues, wrote.
Wong and colleagues created a model to evaluate cost effectiveness of four screening methods: no screening; screening and treating with interferon and ribavirin; screening and treating with interferon and ribavirin, with direct-acting antiviral (DAAs); or screening with the same treatment options except for patients with genotype 1 infection, who receive an interferon-free regimen with DAAs.
They found that the screen-and-treat strategies for adults aged 25 to 64 years were more costly than no screening, but they also were effective. For every 10,000 people screened, there would be approximately 63 cases of HCV identified, of which 37 (59%) would be eligible for treatment. Treating these cases would avert nine HCV-related deaths if interferon and ribavirin were used, and 18 HCV-related deaths if DAAs were used.
If interferon and ribavirin were used, the health benefit was 0.0032 quality-adjusted life-years (QALYs) gained per person screened. Screening increased HCV-related costs by $124 per person, for an incremental cost-effectiveness ratio of $38,117 per QALY gained. For treatment with interferon, ribavirin and DAAs, the health benefit was 0.0063 QALYs gained per person screened and increased HCV-related costs by $267, for an incremental cost-effective ratio of $42,398 per QALY gained. Lastly, with DAA treatment alone, the health benefit was 0.0077 QALYs gained per person, a cost increase of $266 per person, and an incremental cost-effectiveness ratio of $34,783 per QALY gained.
When considering only the population aged 45 to 64 years, the cost-effectiveness ratios increased from $34,359 per QALY for treatment with interferon and ribavirin to $35,562 per QALY for treatment with interferon-free treatment with DAAs to $44,034 for interferon, ribavirin and DAA therapy.
“Early recognition of infected individuals and linkage of these people with care, treatment, alcohol and other lifestyle counseling, and other forms of support could reduce the large pool of undiagnosed HCV infections, save and prolong the lives of people with such infections, and avert the lengthy hospital stays and costs associated with HCV-related end-stage liver disease, liver transplant and hepatocellular carcinoma,” the researchers wrote.
Photo Nitika Pant Pai