Cost-effectiveness analysis of strategies for hepatitis C screening in French blood recipients.
BACKGROUND
In a context of scarce health resources and varied medical practices, the aim of this study was to compare cost-effectiveness of different screening strategies for hepatitis C virus among blood recipients.


METHODS
A cost-effectiveness model was used to test nine screening strategies in three survival categories. Three Markov models were used for three methods of follow-up. The marginal cost-effectiveness ratio was estimated to compare the screening strategies.


RESULTS
Hepatitis C virus serology by enzyme-linked immunosorbent assay and confirmation by detection of the virus RNA was proved to be the dominant strategy. The marginal cost-effectiveness ratios were for subjects under 40 and low-volume transfusion patients, 776,474 and 2,636,500 French Francs-1996 (about USD 111,000 and 376,650) per life-year gained, respectively. Sensitivity analysis showed that the marginal cost-effectiveness ratio was influenced by the prevalence and the survival rates. The lower marginal cost-effectiveness ratio was estimated at 690,221 French Francs-1996 per life-year gained.


CONCLUSIONS
This study showed high costs and few life-years gained for the dominant strategy even for the more favourable risk group. New studies may be carried out for new screening and therapeutic strategies.
Jusot
J F
JF
Medical Evaluation Unit, Départment d'Information Médicale des Hospices Civils de Lyon, Lyon, France. JF.Jusot@wanadoo.fr
Colin
C
C
D000328:Adult; D001803:Blood Transfusion / Q000191:economics; D003362:Cost-Benefit Analysis; D004797:Enzyme-Linked Immunosorbent Assay; D005602:France / Q000453:epidemiology; D006526:Hepatitis C / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D015995:Prevalence; D015996:Survival Rate; D065227:Transfusion Reaction