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Healthcare value of implementing hepatitis C screening in the adult general population in Spain

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  • María Buti
  • Raquel Domínguez-Hernández
  • Miguel Ángel Casado
  • Eliazar Sabater
  • Rafael Esteban

Abstract

Background: Elimination of hepatitis C virus (HCV) infection requires high diagnostic rates and universal access to treatment. Around 40% of infected individuals are unaware of their infection, which indicates that effective screening strategies are needed. We analyzed the efficiency (incremental cost-utility ratio, ICUR) of 3 HCV screening strategies: a) general population of adults, b) high-risk groups, and c) population with the highest anti-HCV prevalence plus high-risk groups. Methods: An analytical decision model, projecting progression of the disease over a lifetime, was used to establish the candidate population for HCV screening. HCV data were obtained from the literature: anti-HCV prevalence (0.56%-1.54%), viremic patients (31.5%), and percentage of undiagnosed persons among those with viremia (35%). It was assumed that most patients would be treated and have HCV therapy response (98% SVR); transition probabilities, utilities, and disease management annual costs were obtained from the literature. Efficiency over the life of patients under the National Health System perspective was measured as quality-adjusted life years (QALY) and total cost (screening, diagnosis, pharmacological and disease management). A discount rate of 3% was applied to costs and outcomes. Results: Screening of the adult population would identify a larger number of additional chronic hepatitis C cases (N = 52,694) than screening the highest anti-HCV prevalence population plus high-risk groups (N = 42,027) or screening high-risk groups (N = 26,128). ICUR for the general population vs. high-risk groups was €8914/QALY gained per patient (€18,157 incremental cost and 2.037 QALY). ICUR for the general population vs. population with highest anti-HCV prevalence plus high-risk groups was €7,448/QALY gained per patient (€7,733 incremental cost and 1.038 QALY). These ICUR values are below the accepted efficiency threshold (€22,000-€30,000). Conclusion: HCV screening and treatment of the general adult population is cost-effective compared to screening of high-risk groups or the population with the highest anti-HCV prevalence plus high-risk groups.

Suggested Citation

  • María Buti & Raquel Domínguez-Hernández & Miguel Ángel Casado & Eliazar Sabater & Rafael Esteban, 2018. "Healthcare value of implementing hepatitis C screening in the adult general population in Spain," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-16, November.
    • Handle: RePEc:plo:pone00:0208036
    DOI: 10.1371/journal.pone.0208036
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    1. Government of India, 2017. "National Health Policy 2017," Working Papers id:11664, eSocialSciences.
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