Article first published online: 18 MAR 2012
Copyright © 2011 American Association for the Study of Liver Diseases
Volume 55, Issue 5, pages 1344–1355, May 2012
How to Cite
McGarry, L. J., Pawar, V. S., Panchmatia, H. R., Rubin, J. L., Davis, G. L., Younossi, Z. M., Capretta, J. C., O'Grady, M. J. and Weinstein, M. C. (2012), Economic model of a birth cohort screening program for hepatitis C virus. Hepatology, 55: 1344–1355. doi: 10.1002/hep.25510
Potential conflict of interest: All authors were paid consultants to Vertex.
This research was commissioned by Vertex Pharmaceuticals Incorporated (Cambridge, MA), a global biotechnology company. The funding source formulated the initial study questions and provided copyright release for the manuscript for this article, but did not participate in the data search, analysis, or interpretation of results.
- Issue published online: 19 APR 2012
- Article first published online: 18 MAR 2012
- Accepted manuscript online: 2 DEC 2011 01:21AM EST
- Manuscript Accepted: 17 NOV 2011
- Manuscript Received: 21 MAR 2011
Recent research has identified high hepatitis C virus (HCV) prevalence among older U.S. residents who contracted HCV decades ago and may no longer be recognized as high risk. We assessed the cost-effectiveness of screening 100% of U.S. residents born 1946-1970 over 5 years (birth-cohort screening), compared with current risk-based screening, by projecting costs and outcomes of screening over the remaining lifetime of this birth cohort. A Markov model of the natural history of HCV was developed using data synthesized from surveillance data, published literature, expert opinion, and other secondary sources. We assumed eligible patients were treated with pegylated interferon plus ribavirin, with genotype 1 patients receiving a direct-acting antiviral in combination. The target population is U.S. residents born 1946-1970 with no previous HCV diagnosis. Among the estimated 102 million (1.6 million chronically HCV infected) eligible for screening, birth-cohort screening leads to 84,000 fewer cases of decompensated cirrhosis, 46,000 fewer cases of hepatocellular carcinoma, 10,000 fewer liver transplants, and 78,000 fewer HCV-related deaths. Birth-cohort screening leads to higher overall costs than risk-based screening ($80.4 billion versus $53.7 billion), but yields lower costs related to advanced liver disease ($31.2 billion versus $39.8 billion); birth-cohort screening produces an incremental cost-effectiveness ratio (ICER) of $37,700 per quality-adjusted life year gained versus risk-based screening. Sensitivity analyses showed that reducing the time horizon during which health and economic consequences are evaluated increases the ICER; similarly, decreasing the treatment rates and efficacy increases the ICER. Model results were relatively insensitive to other inputs. Conclusion: Birth-cohort screening for HCV is likely to provide important health benefits by reducing lifetime cases of advanced liver disease and HCV-related deaths and is cost-effective at conventional willingness-to-pay thresholds. (HEPATOLOGY 2012)