Details:

Alternative Title:
Ann Intern Med
Publisher's site:
http://dx.doi.org/10.7326/0003-4819-156-4-201202210-00378
Personal Author:
Rein, David B. ; Smith, Bryce D. ; Wittenborn, John S. ; Lesesne, Sarah B. ; Wagner, Laura D. ; ... More +
Rein, David B. ; Smith, Bryce D. ; Wittenborn, John S. ; Lesesne, Sarah B. ; Wagner, Laura D. ; Roblin, Douglas W. ; Patel, Nita ; Ward, John W. ; Weinbaum, Cindy M. ; Less -
Description:
Background In the United States, hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and approximately 50% to 75% of infected adults are unaware of their infection. Objective To estimate the cost-effectiveness of birth-cohort screening. Design Cost-effectiveness simulation. Data Sources National Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, and published sources. Target Population Adults born from 1945 through 1965 with 1 or more visits to a primary care provider annually. Time Horizon Lifetime. Perspective Societal, health care. Intervention One-time antibody test of 1945–1965 birth cohort. Outcome Measures Numbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted life-years (QALYs); incremental cost-effectiveness ratio (ICER). Results of Base-Case Analysis Compared with the status quo, birth-cohort screening identified 808 580 additional cases of chronic HCV infection at a screening cost of $2874 per case identified. Assuming that birth-cohort screening was followed by pegylated interferon and ribavirin (PEG-IFN + R) for treated patients, screening increased QALYs by 348 800 and costs by $5.5 billion, for an ICER of $15 700 per QALY gained. Assuming that birth-cohort screening was followed by direct-acting antiviral plus PEG-IFN + R treatment for treated patients, screening increased QALYs by 532 200 and costs by $19.0 billion, for an ICER of $35 700 per QALY saved. Results of Sensitivity Analysis The ICER of birth-cohort screening was most sensitive to sustained viral response of antiviral therapy, the cost of therapy, the discount rate, and the QALY losses assigned to disease states. Limitation Empirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce. Conclusion Birth-cohort screening for HCV in primary care settings was cost-effective. Primary Funding Source Division of Viral Hepatitis, Centers for Disease Control and Prevention.
Subject:
[+]
Aged
Antiviral Agents
Cohort Studies
Computer Simulation
Cost-Benefit Analysis
Hepatitis C, Chronic
Hepatitis C Antibodies
Humans
Interferon-alpha
Markov Chains
Mass Screening
Middle Aged
Primary Health Care
Quality-Adjusted Life Years
Ribavirin
Sensitivity And Specificity

Source:
Ann Intern Med. 156(4):263-270. ;
Pubmed ID:
22056542
Pubmed Central ID:
PMC5484577
Document Type:
Journal Article ;
Funding:
CC999999/Intramural CDC HHS/United States ; 200-2003-02489-0007/PHS HHS/United States ;
CC999999/Intramural CDC HHS/United States ; 200-2003-02489-0007/PHS HHS/United States ; Less -
Place as Subject:
United States ;
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:6183422539cbe158126f05a561a06b223add0efafdad4d30d367930685fd63b3
File Type:

Supporting Files

• 	NIHMS864385-supplement-Sup1.pdf	pdf
  	NIHMS864385-supplement-Sup2.pdf	pdf
  	NIHMS864385-supplement-Sup3.pdf	pdf
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  	nihms864385f1.gif	gif
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