In an era of highly effective treatment, hepatitis C screening of?the United States general population should be considered

摘要

Abstract Background & Aims Hepatitis C virus ( HCV ) treatment with all oral direct acting antiviral agents ( DAA 's) achieve sustained virologic response ( SVR ) rates of 98%. Re‐assessment of general US population screening for HCV is imperative. This study compared the cost‐effectiveness ( CE ) of three HCV screening strategies: screen all ( SA ), screen Birth Cohort ( BCS ), and screen high risks ( HRS ). Methods Using a previous designed decision‐analytic Markov model, estimations of the natural history of HCV and CE evaluation of the three HCV screening strategies over a lifetime horizon in the US population was undertaken. Based on age and risk status, 16 cohorts were modelled. Health states included: Fibrosis stages 0 to 4, decompensated cirrhosis, hepatocellular carcinoma, LT , post‐ LT , and death. The probability of liver disease progression was based on the presence or absence of virus. Treatment was with approved all‐oral DAA s; 86% were assumed to be seen annually by a primary care provider; SVR rates, transition probabilities, utilities, and costs were from the literature. One‐way sensitivity analyses tested the impact of key model drivers. Results SA cost $272.0 billion [$135?279 per patient] and led to 12.19 QALY s per patient. BCS and HRS cost $274.5 billion ($136?568 per patient) and $284.5 billion ($141?502 per patient) with 11.65 and 11.25 QALY s per patient respectively. Compared to BCS , SA led to an additional 0.54 QALY s per patient and saved $2.59 billion; compared to HRS , SA led to 0.95 additional QALY s per patient and saved $12.5 billion. Conclusions Screening the entire US population and treating active viraemia was projected as cost‐saving.