In the Journals

Universal HCV screening in adults cost-effective, decreases prevalence

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.

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.