Research finds targeted screening for hepatitis C is cost-effective

April 24, 2013

Researchers at the University of Cincinnati have found that targeted screening for populations with a higher estimated prevalence for hepatitis C may be cost-effective.

These findings, published in the April 24, 2013, online edition of the journal Clinical Infectious Diseases, indicate that targeted for is cost-effective when the prevalence of hepatitis C in a population exceeds 0.84 percent (84/10,000).

The study further demonstrates how a , which can be incorporated into an electronic health record, can target such patients and help in preventing the spread of the illness.

Mark Eckman, MD, Alice Margaret Posey Professor of Internal Medicine, professor in the division of general internal medicine and UC Health physician, and Kenneth Sherman, MD, PhD, Robert & Helen Gould Endowed Chair, professor in the division of digestive diseases and UC Health physician, co-authored the study.

"Hepatitis C is the most common chronic blood-borne infection in the United States and will become an increasing source of morbidity and mortality with aging of the infected population," says Sherman, adding that hepatitis C is a viral disease that leads to inflammation of the liver and can be spread through exchange of bodily fluids with an infected person.

"Our objective in this study was to develop decision analytic models, exploring the cost-effectiveness of screening in populations with varying prevalence of hepatitis C and risks for liver fibrosis—or scarring—in those with the illness who do not receive treatment. Liver fibrosis results in a damaged liver, and the patient eventually needs a transplant, increasing cost of care."

Researchers developed a computerized Markov state transition model—a mathematical framework for modeling decision-making in situations where outcomes are partly due to chance and partly under the control of a decision maker—to examine screening in a U.S. community whose residents showed no symptoms.

"The base case was an ethnically and gender-mixed adult population with no prior knowledge of diagnosis: 49 percent male, 78 percent white, 13 percent black and 9 percent Hispanic, with a mean age of 46 years," says Eckman.

The model explored strategies of screening followed by guideline-based treatment, if needed, and not screening. Effectiveness was measured in quality-adjusted life years (QALYs)—accounting for both duration of survival and quality of life—and costs were measured in U.S. dollars.

"In the base case, screening followed by guideline-based treatment—using boceprevir as the standard antiviral treatment—of those with chronic hepatitis C infection cost roughly $47,000 per QALY—a 'cost-effective' result," says Eckman. "The overall C prevalence in the U.S. is reported to be between 1.3 and 1.9 percent, but prevalence varies among patients with different risk factors."

He continues that the marginal cost-effectiveness ratio (mCER) of screening decreases as prevalence increases.

"Below a prevalence of 0.84 percent within a population, the mCER is greater than the generally accepted societal willingness-to-pay threshold of $50,000 per QALY," he says. "Therefore, it is not considered highly cost-effective. However, by targeting screening in populations with a higher estimated prevalence, screening and subsequent treatment of those infected would be cost effective."

"Recently released guidelines by the Centers for Disease Control and Prevention advocate 'birth-cohort' focused screening for those born between 1945 and 1965. However, such a strategy may miss screening higher risk patients born in years outside of this cohort," Eckman adds. "Alternatively, patients with no risk factors for infection, other than their membership in the 'birth cohort,' may be at a low enough risk to make their screening less cost-effective."

Eckman and Sherman "argue for the development and proliferation of tools to assist in the implementation of guidelines. The increasing use of and computerized order entry create new opportunities to marry guidelines to practice."

"Perhaps in this manner, targeted and cost-effective screening can become a reality," says Eckman.

Explore further: Screening for hepatitis B may be cost-effective for more of the population, analysis shows

Related Stories

Screening for hepatitis B may be cost-effective for more of the population, analysis shows

May 3, 2011
Hepatitis B virus (HBV) continues to be a major health issue in the United States despite prevention strategies.

Birth cohort screening for hepatitis C is cost effective, could save thousands of lives each year

November 4, 2011
According to a new study being published early online in Annals of Internal Medicine, the flagship journal of the American College of Physicians, birth cohort screening for hepatitis C is cost effective in the primary care ...

Broader screening for hepatitis C would be cost effective, study suggests

March 14, 2012
Broader screening to identify people infected with hepatitis C virus (HCV) would likely be cost effective, according to a new report published in Clinical Infectious Diseases and available online. Significantly reducing HCV-related ...

Hepatitis B screening before chemo deemed cost-effective

June 20, 2012
(HealthDay) -- Universal hepatitis B virus (HBV) screening before chemotherapy for lymphoma reduces costs in most settings, according to a study published online June 18 in the Journal of Clinical Oncology.

Analysis finds mortality from all causes higher among hepatitis C-infected

June 10, 2011
Although liver-related mortality among those infected with hepatitis C is well-documented, little is known about deaths in these patients that are not related to liver problems. A new study published in Clinical Infectious ...

Recommended for you

Researchers developing new tool to distinguish between viral, bacterial infections

July 28, 2017
Antibiotics are lifesaving drugs, but overuse is leading to one of the world's most pressing health threats: antibiotic resistance. Researchers at the University of Rochester Medical Center are developing a tool to help physicians ...

Finish your antibiotics course? Maybe not, experts say

July 27, 2017
British disease experts on Thursday suggested doing away with the "incorrect" advice to always finish a course of antibiotics, saying the approach was fuelling the spread of drug resistance.

Co-infection with two common gut pathogens worsens malnutrition in mice

July 27, 2017
Two gut pathogens commonly found in malnourished children combine to worsen malnutrition and impair growth in laboratory mice, according to new research published in PLOS Pathogens.

Phase 3 trial confirms superiority of tocilizumab to steroids for giant cell arteritis

July 26, 2017
A phase 3 clinical trial has confirmed that regular treatment with tocilizumab, an inhibitor of interleukin-6, successfully reduced both symptoms of and the need for high-dose steroid treatment for giant cell arteritis, the ...

A large-scale 'germ trap' solution for hospitals

July 26, 2017
When an infectious airborne illness strikes, some hospitals use negative pressure rooms to isolate and treat patients. These rooms use ventilation controls to keep germ-filled air contained rather than letting it circulate ...

Researchers report new system to study chronic hepatitis B

July 25, 2017
Scientists from Princeton University's Department of Molecular Biology have successfully tested a cell-culture system that will allow researchers to perform laboratory-based studies of long-term hepatitis B virus (HBV) infections. ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.