The Cost-Effectiveness of Birth-Cohort Screening for Hepatitis C Antibody in U.S. Primary Care Settings

Details

• Alternative Title:
  Ann Intern Med
• Personal Author:
  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.
• 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.
  
  
• Subjects:
  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

  More +
• 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
• Place as Subject:
  United States
• Volume:
  156
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6183422539cbe158126f05a561a06b223add0efafdad4d30d367930685fd63b3
• Download URL:
  https://stacks.cdc.gov/view/cdc/46442/cdc_46442_DS1.pdf
• File Type:
  [PDF - 164.33 KB ]