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Cost-Effectiveness Analysis of Risk-Factor Guided and Birth-Cohort Screening for Chronic Hepatitis C Infection in the United States

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  • Shan Liu
  • Lauren E Cipriano
  • Mark Holodniy
  • Jeremy D Goldhaber-Fiebert

Abstract

Background: No consensus exists on screening to detect the estimated 2 million Americans unaware of their chronic hepatitis C infections. Advisory groups differ, recommending birth-cohort screening for baby boomers, screening only high-risk individuals, or no screening. We assessed one-time risk assessment and screening to identify previously undiagnosed 40–74 year-olds given newly available hepatitis C treatments. Methods and Findings: A Markov model evaluated alternative risk-factor guided and birth-cohort screening and treatment strategies. Risk factors included drug use history, blood transfusion before 1992, and multiple sexual partners. Analyses of the National Health and Nutrition Examination Survey provided sex-, race-, age-, and risk-factor-specific hepatitis C prevalence and mortality rates. Nine strategies combined screening (no screening, risk-factor guided screening, or birth-cohort screening) and treatment (standard therapy–peginterferon alfa and ribavirin, Interleukin-28B-guided (IL28B) triple-therapy–standard therapy plus a protease inhibitor, or universal triple therapy). Response-guided treatment depended on HCV genotype. Outcomes include discounted lifetime costs (2010 dollars) and quality adjusted life-years (QALYs). Conclusions: The cost-effectiveness of one-time birth-cohort hepatitis C screening for 40–64 year olds is comparable to other screening programs, provided that the healthcare system has sufficient capacity to deliver prompt treatment and appropriate follow-on care to many newly screen-detected individuals.

Suggested Citation

  • Shan Liu & Lauren E Cipriano & Mark Holodniy & Jeremy D Goldhaber-Fiebert, 2013. "Cost-Effectiveness Analysis of Risk-Factor Guided and Birth-Cohort Screening for Chronic Hepatitis C Infection in the United States," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-14, March.
    • Handle: RePEc:plo:pone00:0058975
    DOI: 10.1371/journal.pone.0058975
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    References listed on IDEAS

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    1. Patrick W. Sullivan & Vahram Ghushchyan, 2006. "Preference-Based EQ-5D Index Scores for Chronic Conditions in the United States," Medical Decision Making, , vol. 26(4), pages 410-420, July.
    2. David J. McLernon & John Dillon & Peter T. Donnan, 2008. "Systematic Review: Health-State Utilities in Liver Disease: A Systematic Review," Medical Decision Making, , vol. 28(4), pages 582-592, July.
    3. Shan Liu & Michaël Schwarzinger & Fabrice Carrat & Jeremy D Goldhaber-Fiebert, 2011. "Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients," PLOS ONE, Public Library of Science, vol. 6(12), pages 1-14, December.
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    Cited by:

    1. Lauren E. Cipriano & Thomas A. Weber, 2018. "Population-level intervention and information collection in dynamic healthcare policy," Health Care Management Science, Springer, vol. 21(4), pages 604-631, December.
    2. Lauren E. Cipriano & Shan Liu & Kaspar S. Shahzada & Mark Holodniy & Jeremy D. Goldhaber-Fiebert, 2018. "Economically Efficient Hepatitis C Virus Treatment Prioritization Improves Health Outcomes," Medical Decision Making, , vol. 38(7), pages 849-865, October.
    3. Ting-Yu Ho & Shan Liu & Zelda B. Zabinsky, 2019. "A Multi-Fidelity Rollout Algorithm for Dynamic Resource Allocation in Population Disease Management," Health Care Management Science, Springer, vol. 22(4), pages 727-755, December.
    4. Claudia Geue & Olivia Wu & Yiqiao Xin & Robert Heggie & Sharon Hutchinson & Natasha K Martin & Elisabeth Fenwick & David Goldberg & Consortium and ECDC, 2015. "Cost-Effectiveness of HBV and HCV Screening Strategies – A Systematic Review of Existing Modelling Techniques," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-26, December.
    5. Shan Liu & Margaret L. Brandeau & Jeremy D. Goldhaber-Fiebert, 2017. "Optimizing patient treatment decisions in an era of rapid technological advances: the case of hepatitis C treatment," Health Care Management Science, Springer, vol. 20(1), pages 16-32, March.

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