Efficiency of hepatitis C virus screening strategies in general practice.
Hepatitis C viral infection (HCV) is a frequent and severe disease; screening strategies to-date remain insufficient.


OBJECTIVE
To assess the efficiency of HCV screening of high-risk groups among patients consulting general practitioners.


METHODS
A cost-effectiveness analysis was performed involving general medicine screening practices recorded during a survey of 127 practitioners (10,041 patients) conducted in 1997. A reference strategy, defined as HCV screening for illicit drug users and transfused patients, and five extended strategies, where the screening population was broadened to include other risk groups as well, were considered. Average cost and marginal cost-effectiveness ratios were determined for each extended strategy and compared with those observed for the reference strategy. The sensitivity of HCV screening to funding modalities, HCV seroprevalence and proportion of HCV high-risk groups among patients attending general practitioners was studied.


RESULTS
The reference strategy was the most cost-effective method irrespective of the funding modality considered. Fixed practitioner payment was the least efficient funding modality. The average cost of one positive test was sensitive to variations of HCV seroprevalence in the high-risk group as well as the proportion of high-risk patients among the general practitioners' patients.


CONCLUSIONS
Extension of hepatitis C screening to risk groups other than transfused patients and illicit drug users implies a substantial increase in healthcare costs as well as social consensus for such expenditures.
Josset
Valérie
V
Département d'Epidémiologie et de Santé Publique, Centre Hospitalier Universitaire, Hôpitaux de Rouen. valerie.josset@chu-rouen.fr
Torre
Jean-Philippe
JP
Tavolacci
Marie-Pierre
MP
Van Rossem-Magnani
Vanessa
V
Anselme
Karine
K
Merle
Véronique
V
Godart
Jean
J
Libert
Alain
A
Ladner
Joël
J
Czernichow
Pierre
P
D000328:Adult; D003362:Cost-Benefit Analysis; D005194:Family Practice; D005260:Female; D005602:France / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D010865:Pilot Projects; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires