Results of recent study in France showed that universal screening was the most effective strategy and was cost-effective when treatment was initiated regardless of patient fibrosis stage.
“In Europe, recommendations for hepatitis C virus (HCV) screening still target only people at high risk of infection,” Sylvie Deuffic-Burban, MD, from the Université Lille in France, and colleagues wrote. “From an individual and especially from a societal perspective of HCV eradication, [universal screening] should be implemented. However, when recommending such strategy, rapid initiation of treatment after diagnosis is required.”
To evaluate the effectiveness and costs of different HCV screening strategies, Deuffic-Burban and colleagues designed a decision analysis model that included life expectancy, life expectancy in discounted quality-adjusted life years (QALYs), direct lifetime discounted costs, and incremental cost-effectiveness ratio (ICER) among the general French population of adults.
In a strategy that considered treatment initiation for all patients with fibrosis stage 2 or higher, chronic HCV prevalence among undiagnosed adults aged 18 years to 80 years decreased after 1 year from 0.23% to a range of 0.17% to 0.21%. When the researchers considered treatment for all patients regardless of fibrosis stage, the prevalence decreased to a range of 0.12% to 0.2%.
Compared with current risk-based screening strategies, universal screening of undiagnosed adults resulted in the lowest incidences of hepatic events including cirrhosis (2.36% vs. 3.03%), decompensated cirrhosis (1.92% vs. 2.29%), hepatocellular carcinoma (2.34% vs. 2.54%) and liver-related mortality (5.28% vs. 5.76%).
The most cost-effective strategy was targeting patients aged 40 years to 80 years for a gain of 26,100 euros per QALY and an average saving of 0.05 life years and 0.05 QALYs compared with current risk-based strategies. However, universal screening was more effective than targeting adults aged 40 years to 80 years and remained cost-effective at 31,100 euros per QALY.
Overall, universal screening was most cost-effective if treatment was started at an early stage of infection compared with cases of advanced fibrosis.
“This means that a recommendation for a universal screening strategy must be accompanied by a recommendation for rapid initiation of treatment for all,” the researchers wrote. “Based on these results, the most recent French recommendations call for extending HCV screening to all adults. We expect a decision in favor of universal screening, in addition to the reinforcement of targeted testing, as has been done for HIV.” – by Talitha Bennett
Disclosure: Deuffic-Burban reports receiving grants from Janssen and Merck Sharp & Dohme; consultancy honoraria from AbbVie, Bristol-Myers Squibb, Gilead and Merck Sharp & Dohme; and lecture fees from Bristol-Myers Squibb and Gilead. Please see the full study for all other authors’ relevant financial disclosures.