Infection Control Today (04.24.13)
Aids Weekly Plus
Researchers at the University of Cincinnati investigated decision analytic models to explore the cost-effectiveness of screening in populations with differing prevalence of hepatitis C and risks of liver fibrosis or scarring in infected persons who have not been treated. The researchers—Mark Eckman, MD, the Alice Margaret Posey Professor of Internal Medicine, professor in the division of general internal medicine and University of California (UC) Health physician, and Kenneth Sherman, MD, PhD, Robert and Helen Gould Endowed Chair, professor in the division of digestive diseases, and UC Health physician—developed a computerized Markov state transition mode, a mathematical framework for modeling decision-making in situations where outcome is partly due to chance and partly controlled by a decision maker, to investigate screening in a US community with residents who showed no symptoms.
The model was tested on an ethnically- and gender-mixed adult population that had never been diagnosed. The population (mean age 46 years) was 49 percent male, 78 percent white, 13 percent black, and 9 percent Hispanic. The model explored strategies of screening followed by guideline-based treatment and no screening. Effectiveness was measured in quality-adjusted life years (QALYs), accounting for length of survival and quality of life, and costs were measured in US dollars.
In the base case, screening followed by guideline-based treatment using bocepreivir as the antiviral, for those with chronic hepatitis C infection cost approximately $47,000 per QALY, which the researchers considered a cost-effective result. The marginal cost-effectiveness ratio of screening decreases as prevalence increases so that below a prevalence of 0.84 percent in a population, the marginal cost-effectiveness ratio is greater than the generally accepted societal willingness-to-pay threshold of $50,000 per QALY. In that case it is not considered highly cost effective. By targeting screening in populations with a higher estimated prevalence, screening and treatment of those infected would be cost effective.
The researchers concluded that targeted screening for populations with a higher estimated prevalence for hepatitis C may be cost effective. They also argue for the development and proliferation of tools to assist in the implementation of guidelines as the increasing use of electronic health records and computerized order entry provide new opportunities to combine guidelines and practice.
The full report, “Cost-Effectiveness of Screening for Chronic Hepatitis C Infection in the United States, is published online in the journal Clinical Infectious Diseases, (2013; doi:10.1093/cid/cit069).