Optimization of hepatitis C virus screening strategies by birth cohort in Italy.

Loreta A Kondili,Massimo Galli,Andrea Marcellusi,Sarah Blach,Antonio Craxi,Homie Razavi,Francesco S Mennini,Salvatore Petta,Ivane Gamkrelidze,Stefano Vella,Piter Collaborating Group ,Massimo Puoti

doi:10.1111/liv.14408

Abstract

Background and AimsCost‐effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost‐effective in Italy.MethodsA model was developed to quantify screening and healthcare costs associated with HCV. The model‐estimated prevalence of undiagnosed HCV was used to calculate the antibody screens needed annually, with a €25 000 cost‐effectiveness threshold. Outcomes were assessed under the status quo and a scenario that met the World Health Organization's targets for elimination of HCV. The elimination scenario was assessed under five screening strategies.ResultsA graduated birth cohort screening strategy (graduated screening 1: 1968‐1987 birth cohorts, then expanding to 1948‐1967 cohorts) was the least costly. This strategy would gain approximately 144 000 quality‐adjusted life years (QALYs) by 2031 and result in an 89.3% reduction in HCV cases, compared to an 89.6%, 89.0%, 89.7% and 88.7% reduction for inversed graduated screening, 1948‐77 birth cohort, 1958‐77 birth cohort and universal screening, respectively. Graduated screening 1 yielded the lowest incremental cost‐effectiveness ratio (ICER) of €3552 per QALY gained.ConclusionsIn Italy, a graduated screening scenario is the most cost‐effective strategy. Other countries could consider a similar birth cohort approach when developing HCV screening strategies.

Highlights

Hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality, causing an estimated 71 million infections globally.[1]
The model simulates the natural history of the disease and forecasts disease burden, medical costs and health effects of hepatitis C virus (HCV), assessed under the status quo and a scenario to achieve the World Health Organization (WHO)'s Global Health Sector Strategy (GHSS) targets (80% reduction in incidence of chronic HCV infections between 2015 and 2030, 65% reduction in HCV-related deaths due to chronic HCV infection between 2015 and 2030, 90% diagnosis coverage of the HCV-infected population in 2015 and 80% treatment coverage of the eligible HCV-infected population in 2015)[3] considering five screening strategies: 1. Status quo: only at-risk populations screened in Italy,[2 2]
The universal screening and birth cohort screening scenarios, which achieve all targets of the HCV elimination goals, were found to be cost-effective when compared to the status quo scenario, suggesting a coordinated screening program may be beneficial in moving Italy towards elimination of HCV

Summary

Introduction

Hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality, causing an estimated 71 million infections globally.[1]. Achieving the World Health Organization (WHO)'s Global Health Sector Strategy (GHSS) goals for the elimination of HCV by 20303 has reinvigorated public health initiatives aimed at identifying patients with the disease. While targeted screening program for high-risk populations, such as injection drug users, are necessary for the elimination of HCV,[4,5] more is needed to identify what increases in diagnosis are necessary in the general population of high-endemic countries for achieving elimination. Cost-effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. The model-estimated prevalence of undiagnosed HCV was used to calculate the antibody screens needed annually, with a €25 000 cost-effectiveness threshold. Conclusions: In Italy, a graduated screening scenario is the most cost-effective strategy. Other countries could consider a similar birth cohort approach when developing HCV screening strategies

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