Population-wide HCV screening ‘cost-effective’
MedWire News: Screening for hepatitis C (HCV) should be expanded to the general population, suggest study findings showing that this approach would be cost-effective in the long term compared with screening only high-risk individuals.
In an associated press release, lead study author Phillip Coffin (University of Washington, Seattle, USA) said that the current risk factor-based approach to screening "has failed to identify at least half of those infected, leading to a situation in which a quarter of those newly diagnosed already suffer from cirrhosis of the liver."
Coffin and team reason that in order to significantly reduce HCV-related morbidity and mortality, improved rates of referral, treatment, and cure are required.
To estimate the cost-effectiveness and population-level impact of adding one-time HCV screening of US population aged 20-69 years to current guidelines, the team developed a decision-analytic model for a screening intervention that factored in the costs of managing late-stage liver fibrosis versus the costs of attempting to cure patients of HCV.
The researchers found that the incremental cost per quality-adjusted life-year gained (ICER) of general population screening remained under US$ 50,000 - a widely used threshold for cost-effectiveness - provided that HCV seropositivity in the tested population remained over 0.53%.
Indeed, compared with current guidelines, ICER was $ 7900 for general population screening and $ 4200 for screening by birth-year assuming cost, clinician uptake, and median age of diagnosis were equivalent.
Screening 60% of the general population reduced the total number of liver-related deaths by 3.8% compared with risk factor screening. The addition of improved rates of referral and treatment averted an additional 4.0% of deaths.
When referral, treatment, and sustained viral response were set as optimal, screening 60% of the general population averted an additional 7.1% of liver-related deaths compared with risk factor screening.
General population screening remained cost-effective during sensitivity analyses and during scenarios where background mortality was doubled, all genotype 1 patients were treated with protease inhibitors, and other parameters were set unfavorably for increased screening.
"We need to screen the population, but that won't be enough to make a big difference. Hepatitis is a lot like HIV. The US took a long time to come to the conclusion that we needed to really emphasize testing and efforts to link people to care. Hepatitis C is the same. We need a large scale, coordinated effort to identify people with this infection and make sure they get the care they need," said Coffin in a press release.
Agreeing with the team's views on screening, Sylvie Deuffic-Burban and Yazdan Yazdanpanah (both from INSERM ATIP-AVENIR, Lille, France) said in a linked editorial: "By targeting either birth cohorts or the general population, these screening strategies can only be successful if efforts are implemented to increase acceptability of screening by patients and clinicians, and improve linkage to care."
The findings are published in Clinical Infectious Diseases.
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By Ingrid Grasmo