Abstract
BackgroundChronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany.MethodsWe used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates.ResultsTotal number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening).ConclusionsScreening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.
Highlights
Chronic hepatitis C is a major public health burden
Screening is key to have an efficient decline of the hepatitis C virus (HCV)-infected population in Germany
As the number of detected persons is increasing with more comprehensive screening procedures, full annual treatment capacity is utilized until 2025 in total screening compared to 2018 in no screening
Summary
Chronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. As HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. More than 185 million people have been infected with the hepatitis C virus (HCV) worldwide and approximately 350,000 patients die each year from HCV-related diseases [1]. A large part of infected patients are unaware of their disease and most infections remain undiagnosed until serious complications such as liver cirrhosis and hepatocellular carcinoma occur [7]. Other direct acting antivirals (DAAs) simeprevir, daclatasvir, sofosbuvir/ledipasvir, ombitasvir/ paritaprevir/ritonavir plus dasabuvir, elbasvir/grazoprevir, and pangenotypic effective combinations sofosbuvir/ velpatasvir, sofosbuvir/velpatasvir/voxilaprevir, and glecaprevir/pibrentasvir subsequently followed, leading to interferon-free strategies. DAAs achieve sustained viral response (SVR) rates of > 98%, show minimal adverse effects and shorten treatment duration considerably [8]
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