Hepatitis C virus infection screening reduces mortality and is cost-effective independently of the intervention test

• David Nicolás Pérez ^[1] ; Dalia Elena Morales Arráez ^[1] ; Iván Castilla Rodríguez ^[2] ; Fernando Gutiérrez Nicolás ^[1] ; Felicitas Díaz-Flores Estévez ^[1] ; Antonia de Vera González ^[1] ; Gloria Julia Nazco Casariego ^[1] ; Manuel Hernández Guerra ^[1]
  1. [1] Hospital Universitario de Canarias

     Hospital Universitario de Canarias

     San Cristóbal de La Laguna, España

     
  2. [2] Universidad de La Laguna

     Universidad de La Laguna

     San Cristóbal de La Laguna, España

     
• Localización: Revista Española de Enfermedades Digestivas, ISSN-e 2340-4167, ISSN 1130-0108, Vol. 114, Nº. 12, 2022, págs. 731-737
• Idioma: inglés
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• Resumen

  • Introduction: Chronic infection due to hepatitis C virus (HCV) is frequently asymptomatic even in advanced stages of liver disease. Implementation of a screening program based on different HCV tests may enable an earlier diagnosis of HCV liver disease and subsequent application of highly effective treatment. Patients & methods: A Markov model which compares three different screening strategies for hepatitis C versus no screening in low-risk prevalence (general population) and high-risk prevalence population (people who inject drugs or prison population) was designed, taking into account age at the start of screening and participation. The three strategies were: 1) serological detection of antibodies against the HCV, 2) dried blood spot test (DBS) to detect antibodies against HCV and 3) detection of RNA from HCV. Quality-adjusted life-years (QALY) were taken as a measurement of effectiveness. The incremental cost-effectiveness ratio (ICER) was calculated and a deterministic and probabilistic sensitivity analysis was performed. Results: All three screening strategies were found to be cost-effective with an ICER of €13,633, €12,015 and €12,328/QALY for AntiHCV, DBS-AntiHCV and DBS-RNA HCV, respectively. There was a decrease in mortality due to liver disease in comparison to no screening for AntiHCV (40.7% and 52%), DBS-AntiHCV (45% and 80%) and DBS-RNA HCV (45.2% and 80%) for low-prevalence and high-prevalence populations, respectively. Conclusion: All test interventions for HCV screening are cost-effective for the early detection of HCV infection, also achieving a reduction in mortality. Thus, implementation of screening programs for HCV should not be halted by decisions on monetary policy.