Economic consequences of the implementation of national screening program for chronic HCV infection

ABSTRACT

Background

Chronic HCV infection is still one of the leading causes for liver morbidity and mortality worldwide. Increase in testing and diagnosis would result in early identification of people with chronic infection and would enable timely access to care and treatment, as well as prevent or delay progression of liver disease. The aim of the present study is to examine the cost and benefits of introducing ones per life testing for HCV infection among the group of 39–64 years old people who regularly go to prophylactic examinations in Bulgaria.

Research design and methods

Combined cost-effectiveness and cost-benefit analysis was performed to evaluate the cost-effectiveness and net benefit of three screening approaches.

Results

Screening of the birth-cohort type (aged 39–64 and born before the blood testing became available) provides benefits compared to the current practice of symptomatic testing and leads to more LYGs. Testing among this age group is efficient with an ICER below the proposed by WHO threshold of 1–3 times GDP/capita.

Conclusions

Targeted testing among adults between 39 and 64 years with anti-HCV antibody once per their life in Bulgaria could be considered as cost-effective and provides benefits both for the paying institutions and the patients.

KEYWORDS:

• HCV
• screening
• early diagnosis
• anti-HCV antibody testing
• health policy

Article Highlights

• National screening is considered an effective organized system to fight chronic diseases because through active search we can find asymptomatic patients

• Screening for HCV became one of the major strategic aims of WHO to decrease the morbidity and mortality of chronic HCV worldwide when already highly effective therapy is available

• An approach to targeted testing among adults between 39 and 64 years with anti-HCV antibody once per their life in Bulgaria could be considered as cost-effective and provides benefits both for the paying institutions and the patients

• This is related to increased number of people with HCV found in early stages of the disease in which antiviral therapy is less costly and with shorter duration but also leads to more life years gained and reduced mortality

• The results from the current study could serve as a basis for future evaluation of testing programs for other chronic liver diseases

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

GP and MD contributed to the cost data collection, analyzing and revising, and writing. KT contributed to the clinical data and statistical analysis revising.

Additional information

Funding

This paper was not funded.