Optimization of hepatitis C virus screening strategies by birth cohort in Italy

Kondili, Loreta A., Gamkrelidze, Ivane, Blach, Sarah, Marcellusi, Andrea, Galli, Massimo, Petta, Salvatore, Puoti, Massimo, Vella, Stefano, Razavi, Homie, Craxi, Antonio and Mennini, Francesco (2020) Optimization of hepatitis C virus screening strategies by birth cohort in Italy. Liver International, 40(7), pp. 1545-1555. ISSN (online) 1478-3231


Background and Aims: Cost-effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost-effective in Italy. Methods: A model was developed to quantify costs associated with HCV, denominated in quality-adjusted life years (QALYs). The model-estimated prevalence of undiagnosed HCV was used to calculate the antibody screens needed annually, with a €25,000 cost-effectiveness threshold. Outcomes were assessed under the status quo and a scenario that met the World Health Organization’s targets for elimination of HCV. The elimination scenario was assessed under five screening strategies. Results: A graduated birth cohort strategy (screening 1: 1968–1987 birth cohorts then expanding to 1948–1967 cohorts) was the least costly. This strategy would gain 143,929 QALYs by 2031 and result in an 89.3% reduction in HCV cases, compared to an 89.6%, 89.0%, 89.7%, and 88.7% reduction for inversed graduated screening, 1948–77 birth cohort, 1958–77 birth cohort, and universal screening, respectively. Graduated screening 1 yielded the lowest incremental cost-effectiveness ratio (ICER) of €3,552 per QALY gained. Conclusions: In Italy, a graduated screening scenario is the most cost-effective strategy. Other countries could consider a similar birth-cohort approach when developing screening strategies.

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