title: Screening for Hepatitis C in injecting drug users: a cost utility analysis.
abstract: BACKGROUND
  Hepatitis C is a major public health problem of increasing importance among injecting drug users, among whom screening has been proposed. We therefore estimated the cost utility of screening for hepatitis C infection among people with a history of injecting drug use in contact with drug misuse services.
  
  
  METHODS
  A spreadsheet-based model of screening using ELISA followed by polymerase chain reaction tests and treatment using combination therapy with interferon alpha and ribavirin was developed. Parameters were informed by literature review, expert opinion and a survey of current screening practice in England. A range of one-way sensitivity analyses were carried out to explore uncertainty in the results for cost effectiveness.
  
  
  RESULTS
  Screening for HCV is likely to yield benefits in the population concerned at around 28,000 pounds per quality adjusted life year. This estimate is reasonably stable when explored in extensive one-way sensitivity analysis but appeared sensitive to the proportion of HCV positive people who accept biopsy or treatment and the utility gains associated with successful drug treatment. Important other areas of uncertainty include the effects of mortality from other causes on the cost effectiveness of screening in this population and the time at which symptoms would have led to presentation in the absence of a screening programme.
  
  
  CONCLUSIONS
  Screening for HCV in this population is moderately cost effective, although some caution must remain in accepting this estimate given the current uncertainties in this field, and further research is required.
authors.affiliation: Peninsula Technology Assessment Group, Peninsula Medical School, Universities of Exeter and Plymouth, Dean Clarke House, Southernhay East, Exeter EX1 1PQ. ken.stein@pms.ac.uk
authors.forename: Ken
authors.initials: K
authors.lastname: Stein
authors.forename: Kim
authors.initials: K
authors.lastname: Dalziel
authors.forename: Andrew
authors.initials: A
authors.lastname: Walker
authors.forename: Becky
authors.initials: B
authors.lastname: Jenkins
authors.forename: Alison
authors.initials: A
authors.lastname: Round
authors.forename: Pam
authors.initials: P
authors.lastname: Royle
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004739:England; D004797:Enzyme-Linked Immunosorbent Assay / Q000191:economics; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics; D006801:Humans; D007372:Interferons / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D016133:Polymerase Chain Reaction / Q000191:economics; D019057:Quality-Adjusted Life Years; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000191:economics / Q000821:virology*
chemical_list: D000998:Antiviral Agents; D007372:Interferons