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.