The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings

Abstract

Background: In the United States, hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and approximately 50% to 75% of infected adults are unaware of their infections. Objective: To estimate the cost-effectiveness of birth-cohort screening. Design: Cost-effectiveness simulation. Data Sources: National Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, published sources. Target Population: Adults born from 1945 through 1965 with 1 or more visits to a primary care provider annually. Time Horizon: Lifetime. Perspective: Societal, health care. Interventions: One-time antibody test of 1945-1965 birth cohort. Outcome Measures: Numbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted life-years (QALYs); incremental cost-effectiveness ratio (ICER). Results of Base-Case Analysis: Compared with the status quo, birth-cohort screening identified 808 580 additional cases of chronic HCV infection at a screening cost of $2874 per case identified. Assuming that birth-cohort screening was followed by pegylated interferon (pegIFN+R) and ribavirin for treated patients, screening increased QALYs by 348 800 and costs by $5.5 billion, for an ICER of $15 700 per QALY gained. Assuming that birth-cohort screening was followed by a direct-acting antiviral, pegIFN+R treatment for treated patients, screening increased QALYs by 532 200 and costs by $19.0 billion, for an ICER of $35 700 per QALY saved. Results of Sensitivity Analysis: The ICER of birth-cohort screening was most sensitive to sustained viral response rate of antiviral therapy, the cost of therapy, the discount rate and the QALY losses assigned to disease states. Limitation: Empirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce. Conclusion: Birth-cohort screening for HCV in primary care settings was cost-effective. Primary Funding Source: Division of Viral Hepatitis, Centers for Disease Control and Prevention