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Cost-Effectiveness of One-Time Birth Cohort Screening for Hepatitis C as Part of the National Health Service Health Check Program in England.

Authors
  • Williams, Jack1
  • Miners, Alec2
  • Harris, Ross3
  • Mandal, Sema4
  • Simmons, Ruth4
  • Ireland, Georgina4
  • Hickman, Matthew5
  • Gore, Charles6
  • Vickerman, Peter7
  • 1 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England, UK; The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK. Electronic address: [email protected]
  • 2 Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, England, UK; The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK.
  • 3 National Infection Service, Public Health England, Colindale, England, UK.
  • 4 The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK; National Infection Service, Public Health England, Colindale, England, UK.
  • 5 Population Health Sciences, Bristol Medical School, University of Bristol, England, UK; The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, England, UK.
  • 6 The Hepatitis C Trust, London, England, UK.
  • 7 The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, England, UK; Population Health Sciences, Bristol Medical School, University of Bristol, England, UK; The National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, England, UK.
Type
Published Article
Journal
Value in Health
Publisher
Elsevier
Publication Date
Nov 01, 2019
Volume
22
Issue
11
Pages
1248–1256
Identifiers
DOI: 10.1016/j.jval.2019.06.006
PMID: 31708061
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Birth cohort screening for the hepatitis C virus (HCV) has been implemented in the US, but there is little evidence of its cost-effectiveness in England. We aim to evaluate the cost-effectiveness of one-time HCV screening for individuals born between 1950 and 1979 as part of the National Health Service health check in England, a health check for adults aged 40 to 74 years in primary care. A Markov model was developed to analyze add-on HCV testing to the National Health Service health check for individuals in birth cohorts between 1950 and 1979, versus current background HCV testing only, over a lifetime horizon. The model used data from a back-calculation model of the burden of HCV in England, sentinel surveillance of HCV testing, and published literature. Results are presented from a health service perspective in pounds in 2017, as incremental cost-effectiveness ratios per quality-adjusted life years gained. The base-case incremental cost-effectiveness ratios ranged from £7648 to £24 434, and £18 681 to £46 024, across birth cohorts when considering 2 sources of HCV transition probabilities. The intervention is most likely to be cost-effective for those born in the 1970s, and potentially cost-effective for those born from 1955 to 1969. The model results were most sensitive to the source of HCV transition probabilities, the probability of referral and receiving treatment, and the HCV prevalence among testers. The maximum value of future research across all birth cohorts was £11.3 million at £20 000 per quality-adjusted life years gained. Birth cohort screening is likely to be cost-effective for younger birth cohorts, although considerable uncertainty exists for other birth cohorts. Further studies are warranted to reduce uncertainty in cost-effectiveness and consider the acceptability of the intervention. Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.

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