Treating All Patients with Hepatitis C Who Would Be Diagnosed by Age-based Screening Is Cost Effective

BOSTON, Nov. 9, 2014 /PRNewswire/ -- The newest and most effective drugs for the treatment of hepatitis C have a cure rate of up to 98 percent, but the cost of these therapies has been controversial. Accurately assessing the cost of treating all patients with HCV in the US has yet to be determined.

Part of the problem is getting an accurate count of the Americans with HCV as those with HCV are often asymptomatic and many are undiagnosed. The Centers for Disease Control and Prevention (CDC) has recommended a one-time age-based screening of all baby boomers (those born between 1945 and 1965). Risk-based screening was the standard protocol before the CDC's recent recommendation.

Researchers used a decision analytic Markov modeling approach to estimate the cost-effectiveness of screening and treating patients with HCV. They created a model based on five strategies of treatment and simulated patients until death:
  1. Risk-based screening and treating all patients with HCV
  2. Age-based screening and treating all patients with HCV
  3. Risk-based screening and treating patients based on liver disease stage
  4. Age-based screening and treating patients based on liver disease stage
  5. No screening and no treatment
They assumed treatment for fibrosis stages F2 to F4, a 98 percent cure rate, and the cost of the drugs at current prices. They assumed 1.2-1.4 million new patients would be diagnosed with HCV from age-based screening. Treatment effectiveness was measured in quality-adjusted life years, which assumes that patients with HCV would live their lives without HCV progressing to cirrhosis, decompensated liver disease, or liver transplantation. Different screening and treatment strategies were compared to each other based on the standard threshold for cost-effectiveness (incremental cost-effectiveness ratio or ICER) from a societal perspective.

The authors concluded that birth cohort screening followed by treating all HCV (+) patients was the most cost-effective strategy with ICERs well below the accepted threshold of $50,000 per quality adjusted years of life gained. The lead investigator, Zobair Younossi MD, MPH, FAASLD concluded that "screening and treating baby boomers with highly effective and well tolerated all oral anti-HCV regimens are highly cost-effective with great health and economic benefits at the population level." Dr. Younossi is Chairman of Medicine, Inova Fairfax Medical Campus and Vice President for Research, Inova Health system, Falls Church, Virginia.

Abstract title:

The use of all oral regimens for treatment of chronic hepatitis C (CHC) coupled with birth cohort screening is highly cost effective: The health and economic impact on the US population.

SOURCE American Association for the Study of Liver Diseases (AASLD)

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