By Kristina Fiore, Staff Writer, MedPage Today
Published: January 02, 2012
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
Screening patients for hepatitis C virus (HCV) based on their age rather than their risk was cost-effective, researchers found.
Birth-cohort screening would cost between $15,700 and $35,700 per quality of life year (QALY) saved depending on the treatment strategy, putting it in a cost-effectiveness range with other widely implemented preventive interventions, David Rein, PhD, of the University of Chicago, and colleagues reported in the Annals of Internal Medicine.
"[It] appears to be a reasonable strategy to identify asymptomatic cases of HCV," they wrote.
The CDC currently recommends screening patients who may be at risk of HCV, such as injection-drug users or those with elevated alanine aminotransferase levels.
But no more than 50% of patients who are chronically infected with the virus are aware of their status. That may be a result of difficulty implementing risk-based screening methods or the awkwardness of discussing behavioral risks, the researchers said.
Expanding screening recommendations to cover patients born between 1945 and 1965 -- those in whom prevalence of HCV is highest -- may be a complement or alternative to risk-based screening, they wrote, although its impact on healthcare costs has been unknown.
So to estimate the cost-effectiveness of birth cohort screening, Rein and colleagues used data from the National Health and Nutrition Examination Survey (NHANES) 2001-2006 on patients who had at least one or more annual visits to a primary care doctor.
They found that, compared with current practices, birth cohort screening identified an estimated 808,580 additional cases of chronic HCV infection at a cost of $2,874 per case identified.
If birth cohort screening was followed by standard treatment with pegylated interferon and ribavirin, screening increased QALYs by 348,800 and costs by $5.5 billion, for an incremental cost-effectiveness ratio (ICER) of $15,700 per QALY gained.
They added that treatment would prevent 82,300 deaths.
If screening were followed by standard-of-care pegylated interferon plus ribavirin in addition to a direct-acting antiviral, a newer class of HCV drugs, QALYs would be increased by 532,200 and costs by $19 billion, amounting to an ICER of $35,700 per QALY saved.
This treatment strategy would prevent 121,000 deaths, the researchers estimated.
They wrote that although there's no accepted standard for determining what level of cost-effectiveness justifies implementing of a new screening strategy, HCV birth-cohort screening appears to rank on par with colorectal cancer screening, hypertension screening, influenza vaccination of adults ages 50 and up, and vision screening and pneumococcal vaccination of patients ages 65 and up.
They warned that the study had several limitations, including relying on the assumption that patients without insurance weren't offered treatment. Also, cost-effectiveness estimates of direct-acting antivirals plus standard treatment were speculative because actual data on their clinical implementation haven't yet been reported.
They also cautioned that disease progress was capped at 20 years, which may be an underestimate, and the study may lack generalizability because NHANES data don't include information on institutionalized or homeless patients, who may be at risk of HCV.
The study was supported by the CDC.
The researchers reported no conflicts of interest.
Primary source: Annals of Internal Medicine
Source reference:
Rein DB, et al "The cost-effectiveness of birth cohort screening for hepatitis C antibody in U.S. primary care settings" Ann Intern Med 2011.
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