The CEA Registry Blog

By CEA Registry Team on 7/27/2011 2:31 PM

July 28th is World Hepatitis Day.  In recognition, we searched the CEA Registry for estimates of cost-effectiveness of hepatitis C (HCV) screening (Table 1). 

Globally, hepatitis is a hugely burdensome disease with nearly 1 in 12 people suffering from hepatitis. [1]  If left undiagnosed and untreated, hepatitis can lead to disability, liver scarring, and liver cancer. 

The results of our search show a wide range of cost-effectiveness estimates for hepatitis screening, from dominant strategies (more effective and less costly than the comparator) to those that are dominated (less effective and more costly than the comparator).  Strategies that target people with risk factors for contracting hepatitis are the most cost-effective, including strategies targeting injection drug users and the prison population. 
 

Table 1. Cost-effectiveness of hepatitis C screening in a variety of circumstances

Reference
US$/QALY
Intervention      
Comparator      Target Population               
Tramarin 2008 Curr Pharm Des (PMID 18673188) Cost-Saving HCV serology every 6 month, lifelong No screening Injected Drug Users (IDUs) in the Veneto Region, Italy
 
Pereira 2000 Transfusion (11061853) Cost-Saving Screening blood for HCV using current protocols Screening blood for HCV using surrogate markers Blood transfusion recipients
Stein 2004 J Public Health (Oxf) (15044577) 50000 Screening for HCV No Screening Patients with history of drug use
Sutton 2008 J Viral Hepat (18637074) 120000 Screening for HCV Usual care -- symptomatic testing within community Prison population of England and Wales
Stein 2003 J Hepatol (14568266) 150000 Universal screening for HCV No screening    Adult patients attending genitourinary medicine clinics in England
Leal 1999 J Med Screen (10572842) 150000 Screening for HCV    Status quo IV drug users in contact with the health care system in South and West health regions of the UK.
Plunkett 2005 Am J Obstet Gynecol (15846195) 1.40E+06 HCV screening, treatment, and elective cesarean delivery No screening Asymptomatic, HIV-negative pregnant women without risk factors for HCV infection who received routine prenatal care in the US
Pereira 2000 Transfusion (11061853) 2.40E+06 Screening HCV using RNA testing added to current protocols Screening blood for HCV using current protocols Blood transfusion recipients
Plunkett 2005 Am J Obstet Gynecol (15846195) Dominated HCV screening and treatment    No screening Asymptomatic, HIV-negative pregnant women without risk factors who received routine prenatal care in the US
Singer 2001 Am J Med (11755504) Dominated Screening for HCV No screening Asymptomatic, average risk adults (HCV)

 

These findings are consistent with those in Cohen et al 2009. [2]  In certain circumstances screening offers tremendous value, increasing health while decreasing the overall cost of care.  However, in other circumstances screening strategies can be highly cost-ineffective, resulting in little or no health gain for the investment.  While screening offers great potential to increase health and generate cost-savings, it is important to target appropriate populations (e.g., those at risk).

You can find out more information regarding hepatitis, including information on prevention, diagnosis, and treatment at: http://www.worldhepatitisalliance.org.

By: Michael J. Cangelosi and James D. Chambers

References
[1] ELPA-info.org (2010) Avilable Online at:www.elpa-info.org
[2] Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med. 2008 Feb 14;358(7):661-3

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