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Model-based cost-effectiveness estimates of testing strategies for diagnosing hepatitis C virus infection in Central and Western Africa

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  • Léa Duchesne
  • Gilles Hejblum
  • Richard Njouom
  • Coumba Touré Kane
  • Thomas d’Aquin Toni
  • Raoul Moh
  • Babacar Sylla
  • Nicolas Rouveau
  • Alain Attia
  • Karine Lacombe

Abstract

Background: Whereas 72% of hepatitis C virus (HCV)-infected people worldwide live in low- and middle-income countries (LMICs), only 6% of them have been diagnosed. Innovative technologies for HCV diagnosis provide opportunities for developing testing strategies more adapted to resource-constrained settings. However, studies about their economic feasibility in LMICs are lacking. Methods: Adopting a health sector perspective in Cameroon, Cote-d'Ivoire, and Senegal, a decision tree model was developed to compare 12 testing strategies with the following characteristics: a one-step or two-step testing sequence, HCV-RNA or HCV core antigen as confirmative biomarker, laboratory or point-of-care (POC) tests, and venous blood samples or dried blood spots (DBS). Outcomes measures were the number of true positives (TPs), cost per screened individual, incremental cost-effectiveness ratios, and nationwide budget. Corresponding time horizon was immediate, and outcomes were accordingly not discounted. Detailed sensitivity analyses were conducted. Findings: In the base-case, a two-step POC-based strategy including anti-HCV antibody (HCV-Ab) and HCV-RNA testing had the lowest cost, €8.18 per screened individual. Assuming a lost-to-follow-up rate after screening > 1.9%, a DBS-based laboratory HCV-RNA after HCV-Ab POC testing was the single un-dominated strategy, requiring an additional cost of €3653.56 per additional TP detected. Both strategies would require 8–25% of the annual public health expenditure of the study countries for diagnosing 30% of HCV-infected individuals. Assuming a seroprevalence > 46.9% or a cost of POC HCV-RNA

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  • Léa Duchesne & Gilles Hejblum & Richard Njouom & Coumba Touré Kane & Thomas d’Aquin Toni & Raoul Moh & Babacar Sylla & Nicolas Rouveau & Alain Attia & Karine Lacombe, 2020. "Model-based cost-effectiveness estimates of testing strategies for diagnosing hepatitis C virus infection in Central and Western Africa," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-18, August.
    • Handle: RePEc:plo:pone00:0238035
    DOI: 10.1371/journal.pone.0238035
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    References listed on IDEAS

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    1. Don Husereau & Michael Drummond & Stavros Petrou & Chris Carswell & David Moher & Dan Greenberg & Federico Augustovski & Andrew Briggs & Josephine Mauskopf & Elizabeth Loder, 2013. "Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 367-372, June.
    2. Léa Duchesne & Gilles Hejblum & Ndèye Coumba Toure Kane & Richard Njouom & Toni Thomas-d'Aquin & Raoul Moh & Babacar Sylla & Nicolas Rouveau & Alain Attia & Karine Lacombe, 2020. "Model-based cost-effectiveness estimates of testing strategies for diagnosing hepatitis C virus infection in people who use injecting drugs in Senegal," Post-Print hal-02543434, HAL.
    3. Mehnaaz Sultan Khuroo & Naira Sultan Khuroo & Mohammad Sultan Khuroo, 2015. "Diagnostic Accuracy of Point-of-Care Tests for Hepatitis C Virus Infection: A Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-22, March.
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