Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Because Egyptians have high prevalence of hepatitis C virus (HCV) infection, we estimated the cost-effectiveness of screening for HCV infection among Egyptian immigrants in the United States.
Method: We developed a Markov decision analysis model of the natural history of HCV infection and treatment to evaluate the cost-effectiveness of screening Egyptian immigrants in the United States. We used hepatitis C age-specific progression rates and prevalence for Egyptian people while costs are in US dollars and health utilities from Americans have been used with 3% annual discount rates. All data were collected from the literature. We used a societal perspective, measuring costs, quality-adjusted life years (QALYs) gained, and calculated the incremental cost-effectiveness ratio of a hypothetical program of screening and treating Egyptian immigrants for HCV versus no screening. Sensitivity analysis was conducted to test uncertainty in the model assumptions.
Result: Under base case assumptions, a screening program for individuals older than 40 would cost $18,895 for 16.74 QALYs, while non-screening would cost $13,637 for 16.70 QALYs for the 40 year time horizon. The incremental cost-effectiveness ratio (ICER) for implementing a screening program for Egyptian immigrants who are older than 40 years old in the United States compared to no screening is $159,230/QALY. Results were the most sensitive to the utility of chronic hepatitis C infection. When the utility of HCV infection is lower than 0.921, the ICER would be lower than $100,000/QALY.
Conclusion: Implementing a hepatitis C screening program for Egyptian immigrants is relatively expensive according to a variety of commonly-cited thresholds. Except for a reduction in the utility of hepatitis C below 0.921, the analysis is robust to varying other underlying assumptions. Further research expanding this analysis to other immigrant populations with high HCV prevalence are needed.
See more of: The 33rd Annual Meeting of the Society for Medical Decision Making