Abstract
Cost-effective screening strategies are needed to make Hepatitis C virus (HCV) elimination a reality. Our objective was to determine if birth cohort-based screening could be cost-effective in Italy. A Markov disease burden model was developed. An economic impact module was added to quantify medical costs and health effects associated with HCV infection. The cost-effectiveness threshold was set at €25,000. Modeled outcomes for disease burden, medical costs, and health effects of HCV infection were assessed under the status quo and as well as a scenario to achieve the WHO targets for eliminating HCV by 2030 under four screening strategies: the 1948–78 cohort, the 1958–78 cohort, and graduated birth cohort screening (birth years 1958–78 over 2021–23, 1948–78 over 2024–27, and 1948–84 over 2028–30). The graduated screening scenario was the least costly, with €6.0 billion in total medical costs by 2031. This was €107.4 million less than screening in the 1948–77 birth cohort, €109.1 million less than screening in the 1958–77 birth cohort, and €467.1 million less than universal screening. Relative to the status quo, graduated screening would gain 143,929 QALYs by 2031, compared to 142,244, 128,384, and 144,759 QALYs for the 1948–77 birth cohort, the 1958–77 birth cohort, and universal screening, respectively. Graduated screening would see a reduction of 89.3% in prevalent HCV-infected cases over 2018–31, compared to 89.0%, 89.7%, and 88.7% for the 1948–77 birth cohort, the 1958–77 birth cohort, and universal screening, respectively. Graduated screening yielded the lowest ICER of €3,552 per QALY. Universal screening yielded an ICER of €562,855 per QALY relative to graduated screening. Implementing graduated screening in Italy — beginning with the 1968–87 birth cohort in 2020, followed by the screening of the 1948–67 birth cohort from 2023 — was the most cost-effective option, and showed the second largest reduction in overall disease burden by 2031.
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