Abstract
The management of hepatitisC virus (HCV) has changed with the advent of interferon (IFN)-free treatment and the declining prevalence of HCV infection, which may impact the cost-effectiveness of the screening. We aimed to compare the cost-effectiveness and clinical outcomes of three screening strategies in the Japanese general population: no screening, screening plus IFN-based therapy, and screening plus IFN-free therapy. We developed a decision analytic Markov model for screening intervention and natural history of HCV. Model parameters were derived from published literature. A lifetime horizon and the healthcare payer perspective were taken. Subanalyses included high screening scenario with improved rates of screening and attending referral, in addition to heterogeneity analysis by age subgroup. In the base case, the incremental cost-effectiveness ratio in the Japanese general population aged 40-89years was ¥1 124 482 and ¥1 085 183 per quality-adjusted life year gained for screening plus IFN-free therapy compared with no screening and screening plus IFN-based therapy, respectively. Screening plus IFN-free therapy remained cost-effective below ¥5 000 000 per quality-adjusted life year gained in sensitivity analyses. Incremental cost-effectiveness ratios were lower in the younger population. Nearly 0.2% of HCV-related deaths were avoided by 1.5% of the general population screened followed by IFN-free therapy relative to no screening; the impact was greater with improved rates of screening and attending referral. Screening and subsequent IFN-free therapy for HCV appears to be cost-effective. Early diagnosis and treatment would produce a favorable incremental cost-effectiveness ratio. Improved rates of screening and attending referral would result in further reduction of disease progression.
Highlights
An estimated 71 million people have chronic hepatitis C virus (HCV) infection worldwide, and nearly 400,000 patients die annually from HCV-related liver diseases such as liver cirrhosis and hepatocellular carcinoma (HCC).[1]
In Japan, approximately 2 million individuals were estimated to be infected with HCV in the year 2000,2 and approximately 30,000 patients annually die of liver cancer.[3]
The decision model for the screening was based in part on the model of Coffin et al, and it reflected the screening procedure proposed by the Ministry of Health, Labour and Welfare (MHLW) in Japan (Figure 1A).[16,17]
Summary
An estimated 71 million people have chronic hepatitis C virus (HCV) infection worldwide, and nearly 400,000 patients die annually from HCV-related liver diseases such as liver cirrhosis and hepatocellular carcinoma (HCC).[1]. Infection with HCV has a significant public impact; early diagnosis and treatment are important.
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