Abstract
The cost of testing can be a substantial contributor to hepatitis C virus (HCV) elimination program costs in many low- and middle-income countries such as Georgia, resulting in the need for innovative and cost-effective strategies for testing. Our objective was to investigate the most cost-effective testing pathways for scaling-up HCV testing in Georgia. We developed a Markov-based model with a lifetime horizon that simulates the natural history of HCV, and the cost of detection and treatment of HCV. We then created an interactive online tool that uses results from the Markov-based model to evaluate the cost-effectiveness of different HCV testing pathways. We compared the current standard-of-care (SoC) testing pathway and four innovative testing pathways for Georgia. The SoC testing was cost-saving compared to no testing, but all four new HCV testing pathways further increased QALYs and decreased costs. The pathway with the highest patient follow-up, due to on-site testing, resulted in the highest discounted QALYs (124 QALY more than the SoC) and lowest costs ($127,052 less than the SoC) per 10,000 persons screened. The current testing algorithm in Georgia can be replaced with a new pathway that is more effective while being cost-saving.
Highlights
Chronic hepatitis C virus (HCV) infection is a global health problem that affects about 71 million people worldwide[1]
Natural history outcomes from this model have been validated previously[11,12,13]. We adapted this model to simulate the epidemiology of HCV in Georgia (MATCHGeorgia), and extended the model to evaluate the cost-effectiveness of several innovative HCV testing pathways for Georgia
HCV screening under the SoC increased discounted quality-adjusted life years (QALYs) by 333 per 10,000 people screened and decreased costs by US $290,942 (Table 3)
Summary
Chronic hepatitis C virus (HCV) infection is a global health problem that affects about 71 million people worldwide[1]. The World Health Organization (WHO) recently launched a global strategy for elimination of HCV as a public health threat by the year 2030 This strategy aims to reduce HCV incidence by 80% and HCV-related mortality by 65%3. A recent study concluded that to achieve the goal of eliminating HCV as a public health threat in Georgia, innovative, simple, and cost-effective strategies are needed to scale-up HCV testing[9,10]. To help address this issue, the Foundation for Innovative Diagnostics (FIND) has proposed new testing pathways for HCV in Georgia. Parameter Age (median), years[15] Fibrosis score distribution[6] F0 F1 F2 F3 F4 Sex distribution Male Female Virus genotype distribution6,7,16* G1 G2 G3 G4
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