title: The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings.
abstract: BACKGROUND
  In the United States, hepatitis C virus (HCV) infection is most prevalent among adults born from 1945 through 1965, and approximately 50% to 75% of infected adults are unaware of their infection.
  
  
  OBJECTIVE
  To estimate the cost-effectiveness of birth-cohort screening.
  
  
  METHODS
  Cost-effectiveness simulation.
  
  
  METHODS
  National Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, and published sources.
  
  
  METHODS
  Adults born from 1945 through 1965 with 1 or more visits to a primary care provider annually.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Societal, health care.
  
  
  METHODS
  One-time antibody test of 1945-1965 birth cohort.
  
  
  METHODS
  Numbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted life-years (QALYs); incremental cost-effectiveness ratio (ICER).
  
  
  RESULTS
  Compared with the status quo, birth-cohort screening identified 808,580 additional cases of chronic HCV infection at a screening cost of $2874 per case identified. Assuming that birth-cohort screening was followed by pegylated interferon and ribavirin (PEG-IFN+R) for treated patients, screening increased QALYs by 348,800 and costs by $5.5 billion, for an ICER of $15,700 per QALY gained. Assuming that birth-cohort screening was followed by direct-acting antiviral plus PEG-IFN+R treatment for treated patients, screening increased QALYs by 532,200 and costs by $19.0 billion, for an ICER of $35,700 per QALY saved.
  
  
  RESULTS
  The ICER of birth-cohort screening was most sensitive to sustained viral response of antiviral therapy, the cost of therapy, the discount rate, and the QALY losses assigned to disease states.
  
  
  CONCLUSIONS
  Empirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce.
  
  
  CONCLUSIONS
  Birth-cohort screening for HCV in primary care settings was cost-effective.
  
  
  BACKGROUND
  Division of Viral Hepatitis, Centers for Disease Control and Prevention.
authors: NORC at the University of Chicago, Illinois, USA. rein-david@norc.org
authors: David B
authors: DB
authors: Rein
authors: Bryce D
authors: BD
authors: Smith
authors: John S
authors: JS
authors: Wittenborn
authors: Sarah B
authors: SB
authors: Lesesne
authors: Laura D
authors: LD
authors: Wagner
authors: Douglas W
authors: DW
authors: Roblin
authors: Nita
authors: N
authors: Patel
authors: John W
authors: JW
authors: Ward
authors: Cindy M
authors: CM
authors: Weinbaum
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003198:Computer Simulation; D000075202:Contraindications; D003362:Cost-Benefit Analysis; D018937:Hepatitis C Antibodies / Q000097:blood*; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents; D018937:Hepatitis C Antibodies; D016898:Interferon-alpha; D012254:Ribavirin