Assessing the cost-effectiveness of hepatitis C screening strategies in France.
J Hepatol
; 69(4): 785-792, 2018 Oct.
Article
em En
| MEDLINE
| ID: mdl-30227916
ABSTRACT
BACKGROUND & AIMS:
In Europe, hepatitis C virus (HCV) screening still targets people at high risk of infection. We aim to determine the cost-effectiveness of expanded HCV screening in France.METHODS:
A Markov model simulated chronic hepatitis C (CHC) prevalence, incidence of events, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER) in the French general population, aged 18 to 80â¯years, undiagnosed for CHC for different strategies S1â¯=â¯current strategy targeting the at risk population; S2â¯=â¯S1 and all men between 18 and 59â¯years; S3â¯=â¯S1 and all individuals between 40 and 59â¯years; S4â¯=â¯S1 and all individuals between 40 and 80â¯years; S5â¯=â¯all individuals between 18 and 80â¯years (universal screening). Once CHC was diagnosed, treatment was initiated either to patients with fibrosis stage ≥F2 or regardless of fibrosis. Data were extracted from published literature, a national prevalence survey, and a previously published mathematical model. ICER were interpreted based on one or three times French GDP per capita (32,800).RESULTS:
Universal screening led to the lowest prevalence of CHC and incidence of events, regardless of treatment initiation. When considering treatment initiation to patients with fibrosis ≥F2, targeting all people aged 40-80 was the only cost-effective strategy at both thresholds (26,100/QALY). When we considered treatment for all, although universal screening of all individuals aged 18-80 is associated with the highest costs, it is more effective than targeting all people aged 40-80, and cost-effective at both thresholds (31,100/QALY).CONCLUSIONS:
In France, universal screening is the most effective screening strategy for HCV. Universal screening is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of HCV eradication, this strategy should be implemented. LAYSUMMARY:
In the context of highly effective and well tolerated therapies for hepatitis C virus that are now recommended for all patients, a reassessment of hepatitis C screening strategies is needed. An effectiveness and cost-effectiveness study of different strategies targeting either the at-risk population, specific ages or all individuals was performed. In France, universal screening is the most effective strategy and is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of hepatitis C virus eradication, this strategy should be implemented.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Hepatite C Crônica
Tipo de estudo:
Diagnostic_studies
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Health_economic_evaluation
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Prognostic_studies
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Risk_factors_studies
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Screening_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article