Journal Article

Elimination of hepatitis C virus in Germany: modelling the cost-effectiveness of HCV screening strategies

Rossol, Siegbert, Herder, Babette, Kautz, Achim, Krauth, Christian, Stahmeyer, Jona Theodor, Ortsäter, Gustaf, Krüger, Kathrin

2019

Overview

Background Chronic hepatitis C is a major public health burden. With new interferon-free direct-acting agents (showing sustained viral response rates of more than 98%), elimination of HCV seems feasible for the first time. However, as HCV infection often remains undiagnosed, screening is crucial for improving health outcomes of HCV-patients. Our aim was to assess the long-term cost-effectiveness of a nationwide screening strategy in Germany. Methods We used a Markov cohort model to simulate disease progression and examine long-term population outcomes, HCV associated costs and cost-effectiveness of HCV screening. The model divides the total population into three subpopulations: general population (GEP), people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM), with total infection numbers being highest in GEP, but new infections occurring only in PWIDs and MSM. The model compares four alternative screening strategies (no/basic/advanced/total screening) differing in participation and treatment rates. Results Total number of HCV-infected patients declined from 275,000 in 2015 to between 125,000 (no screening) and 14,000 (total screening) in 2040. Similarly, lost quality adjusted life years (QALYs) were 320,000 QALYs lower, while costs were 2.4 billion EUR higher in total screening compared to no screening. While incremental cost-effectiveness ratio (ICER) increased sharply in GEP and MSM with more comprehensive strategies (30,000 EUR per QALY for total vs. advanced screening), ICER decreased in PWIDs (30 EUR per QALY for total vs. advanced screening). Conclusions Screening is key to have an efficient decline of the HCV-infected population in Germany. Recommendation for an overall population screening is to screen the total PWID subpopulation, and to apply less comprehensive advanced screening for MSM and GEP.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Antiviral agents / Antiviral Agents - economics / Antiviral Agents - therapeutic use / Biological response modifiers / Boceprevir / Cohort Studies / Computer simulation / Cost analysis / Cost-Benefit Analysis / Cost-effectiveness / Daclatasvir / Dasabuvir / Diagnostic Tests, Routine - economics / Diagnostic Tests, Routine - statistics & numerical data / Disease / Disease eradication / Disease Eradication - economics / Disease Eradication - methods / Disease Eradication - statistics & numerical data / Drug Users - statistics & numerical data / Economic aspects / Female / Germany - epidemiology / Health aspects / Health Care Costs / Health screening / Hepacivirus - genetics / Hepacivirus - isolation & purification / Hepatitis / Hepatitis and co-infections / Hepatitis C / Hepatitis C - diagnosis / Hepatitis C - economics / Hepatitis C - epidemiology / Hepatitis C - prevention & control / Hepatitis C virus / Hepatitis C, Chronic - diagnosis / Hepatitis C, Chronic - economics / Hepatitis C, Chronic - epidemiology / Hepatitis C, Chronic - prevention & control / HIV / HIV Infections - diagnosis / HIV Infections - economics / HIV Infections - epidemiology / HIV patients / Homosexuality, Male - statistics & numerical data / Human immunodeficiency virus / Humans / Infection / Infections / Infectious Diseases / Interferon / Internal Medicine / Liver cancer / Liver cirrhosis / Male / Markov model / Markov processes / Mass Screening - economics / Mass Screening - methods / Mass Screening - statistics & numerical data / Medical Microbiology / Medical research / Medicine / Medicine & Public Health / Middle Aged / Mortality / Parasitology / Population / Population decline / Population Surveillance - methods / Protease inhibitors / Public health / Public health movements / Quality-Adjusted Life Years / Research Article / Screening / Sexual and Gender Minorities - statistics & numerical data / Sexually transmitted diseases / Simeprevir / Sofosbuvir / STD / Subpopulations / Telaprevir / Tropical Medicine / Viruses