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Birth cohort testing and treatment for HCV in the USA

July's issue of Hepatology investigates the impact of timing and prioritization on the cost-effectiveness of birth cohort testing and treatment for hepatitis C virus in the United States.

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Recent United States guidelines recommend one-time birth cohort testing for hepatitis C infection in persons born between 1945 and 1965.

This represents a major public health policy undertaking.

Dr Phil McEwan and colleagues from the United Kingdom assessed the role of treatment timing and prioritization on predicted cost-effectiveness.

The team used a MONARCH hepatitis C lifetime simulation model in conjunction with a testing and treatment decision tree to estimate the cost-effectiveness of birth cohort versus risk-based testing incorporating information on age, fibrosis stage and treatment timing.

The study used a 1945-1965 birth cohort and included disease progression, testing and treatment-related parameters.

Scenario analysis was used to evaluate the impact of hepatitis C virus prevalence, treatment eligibility, age, fibrosis stage and timing of treatment initiation on total costs, quality-adjusted life years, hepatitis C virus-related complications and cost-effectiveness.

Prioritizing treatment was associated with a decrease in a total cost of $7.5 billion
Hepatology

The researchers found the cost-effectiveness of birth cohort versus risk-based testing was $28,602.

Assuming 91% of the population is tested, at least 278,000 people need to be treated for birth cohort testing to maintain cost-effectiveness.

The team noted that prioritizing treatment toward those with more advanced fibrosis is associated with a decrease in a total cost of $7.5 billion, and 59,035 fewer hepatitis C virus-related complications.

Total quality-adjusted life years and complications avoided are maximized when treatment initiation occurs as soon as possible after testing.

Dr McEwan's team comments, "This study confirms that birth cohort testing is, on average, cost-effective."

"However, this remains true only when enough tested and hepatitis C virus-positive subjects are treated to generate sufficient cost offsets and quality-adjusted life years gains."

"Given the practical and financial challenges associated with implementing birth cohort testing, the greatest return on investment is obtained when eligible patients are treated immediately and those with more advanced disease are prioritized."

Hepatology 2013: 58(1): (54–64)
22 July 2013

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