Costs and cost-effectiveness of different follow-up schedules for detection of occupational hepatitis C virus infection.
OBJECTIVE
The purpose of this study was to compare the costs and cost-effectiveness (C/E) of early hepatitis C virus (HCV) RNA testing (alternative-US recommendations) after occupational exposure to HCV with existing follow-up strategies: (1) French, anti-HCV antibodies and alanine transaminase (ALT) activity at months 1, 3 and 6; (2) European, monthly ALT activity for 4 months and anti-HCV antibodies at month 6; (3) and baseline-US, anti-HCV antibodies and ALT activity at month 6.


METHODS
A decision tree simulated each strategy for 7300 healthcare workers (HCWs) exposed to HCV each year in France, taking into account the impact of early diagnosis on the response to antiviral treatment and the deterioration of HCW quality of life after exposure.


RESULTS
For a HCV transmission risk of 0.5% after exposure, the French strategy led to the highest costs/person (181.40 euros) and the baseline-US strategy to the lowest (126.60 euros) (178.50 euros) for alternative-US). The shortest mean time to HCV infection diagnosis (1 month) and the lowest number of chronic hepatitis C (CHC) patients (1.9/7300 HCWs exposed) was obtained with the alternative-US strategy (vs 6 months and 7.9 CHC, respectively with baseline-US). Compared with the alternative-US, the French strategy was associated with higher costs and lower utilities, and the European with a higher incremental C/E ratio. Compared with the baseline-US strategy, the alternative-US strategy C/E ratio was 2020 euros per quality-adjusted life year saved.


CONCLUSIONS
In HCWs exposed to HCV, a strategy based on early HCV RNA testing shortens the period during which the HCW's wait for his HCV status, leads to lower risk of progression to CHC and is reasonably cost-effective.
Deuffic-Burban
S
S
LEM-CNRS, Université Catholique de Lille, 41 rue du Port, 59046 Lille Cedex, France; sylvie.burban@neuf.fr.
Abiteboul
D
D
Lot
F
F
Branger
M
M
Bouvet
E
E
Yazdanpanah
Y
Y
D000208:Acute Disease; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003362:Cost-Benefit Analysis; D042241:Early Diagnosis; D005060:Europe; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006282:Health Personnel; D006302:Health Services Research / Q000379:methods; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics* / Q000635:transmission; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000379:methods; D009784:Occupational Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics*; D016273:Occupational Exposure / Q000009:adverse effects; D011788:Quality of Life; D012367:RNA, Viral / Q000097:blood; D014481:United States
D000998:Antiviral Agents; D015415:Biomarkers; D018937:Hepatitis C Antibodies; D012367:RNA, Viral; D000410:Alanine Transaminase