Prevention could be less cost-effective than cure: the case of hepatitis C screening policies in France.
OBJECTIVE
To access the cost-effectiveness of French recommendations for hepatitis C virus (HCV) screening and the extent to which earlier identification of carriers may or not improve the cost-effectiveness of therapeutic strategies.


METHODS
Cost-effectiveness analysis were performed using decision-tree analysis and a Markov model. Four alternative strategies were compared: no screening and no treatment; initiation of HCV treatment after the diagnosis of cirrhosis; and two alternative strategies refer to the current French policies of HCV testing, i.e., two enzyme immunoblot assay (EIA) tests in series, or a polymerase chain reaction (PCR) analysis after the first positive EIA test. Costs were computed from the viewpoint of the health care system. The analysis has been applied to populations particularly at risk of infection, as well as the general population.


RESULTS
The "wait and treat cirrhosis" strategy was more cost-effective in the general population and in transfusion recipients. The incremental cost-effectiveness ratio of this strategy compared with baseline strategy was 3,476 of euros and Euro15,300 in respective cohorts. Considering the HCV screening strategy, the additional cost would be of Euro4,933 and Euro240,250 per additional year of life saved, respectively. In the intravenous drug user (IDU) population, the "two ElA" screening strategy was the more cost-effective alternative, with an additional cost of Euro3,825 per additional year of life saved.


CONCLUSIONS
HCV screening would be discarded for transfusion recipients but should be encouraged for IDUs and also for the general population, in which the additional cost of screening is an order of magnitude more acceptable.
Loubière
Sandrine
S
The French Medical Institute of Medical Research, INSERM U379-ORS PACA, Marseille, France. loubiere@marseille.inserm.fr
Rotily
Michel
M
Moatti
Jean-Paul
JP
D000328:Adult; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005602:France / Q000453:epidemiology; D006291:Health Policy / Q000191:economics*; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000191:economics* / Q000517:prevention & control*; D006801:Humans; D007124:Immunoenzyme Techniques; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000628:therapy; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D018570:Risk Assessment / Q000191:economics