COST-EFFECTIVENESS OF SCREENING HEPATITIS C IN CANADA

Purpose: The prevalence of chronic hepatitis C (CHC) infection among Canadian is estimated to be between 0.3% and 0.9%, among whom 10-20% develop advanced liver disease by 30 years of infection. Targeted screening seems to be a plausible strategy.  In the U.S.A, currently revised screening recommendations have included persons who are born between 1945 and 1965.  It is very helpful to ascertain if these US recommendations are cost effective in Canada, considering differences in epidemiology and in the health care system. The issue of cost is particularly salient at this time because there are a number of new, effective but expensive regimens for treating CHC in the drug pipeline.  In collaboration with Public Health Agency of Canada (PHAC), the objective of this study is to build a model that can project the health and economic effects of CHC screening strategies in Canada.

Method: We used a state-transition model to examine the cost-effectiveness of three screening strategies: (1) “No screening”; (2) “Screen and treat with pegylated interferon plus ribavirin (PR)” and (3) “Screen and treat with direct-acting antiviral agents (DAA)” for 26 to 65 year-old individuals who are currently living in Canada. Our model includes health states related to fibrosis stages (F0 to F4), presence or absence of a clinical diagnosis, treatment and clinical states (e.g., Cirrhosis, hepatocellular carcinoma (HCC)). Model data were obtained from the published literature.  We used a payer perspective, a lifetime time horizon and a 5% discount rate. 

Result:   For every 10,000 persons screened, screen and treat with PR would prevent 7 decompensated cirrhosis, 4 HCC and 11 HCV-related deaths over the lifetime of the cohort.  Screening was associated with an increase of 0.0042-0.0052 QALYs and cost (C$145-C$187) per person , translating to an ICER of C$34,622/QALY-C$43,637/QALY gained compared with “No screening”, which depends on different antiviral therapies received (Table 1).  Univariate and probabilistic sensitivity analyses suggest that the “Screen and Treat” strategy would likely be cost-effective.

Conclusion: Our analysis suggested that a selective one-time hepatitis C screening program for individuals between 25 and 64 years of age in Canada would likely be cost-effective.  Identification of silent CHC infection with the offer of treatment when appropriate can extend the lives of Canadian at reasonable cost.