title: Cost-effectiveness and population outcomes of general population screening for hepatitis C.
abstract: BACKGROUND
  Current US guidelines recommend limiting hepatitis C virus (HCV) screening to high-risk individuals, and 50%-75% of infected persons remain unaware of their status.
  
  
  METHODS
  To estimate the cost-effectiveness and population-level impact of adding one-time HCV screening of US population aged 20-69 years to current guidelines, we developed a decision analytic model for the screening intervention and Markov model with annual transitions to estimate natural history. Subanalyses included protease inhibitor therapy and screening those at highest risk of infection (birth year 1945-1965). We relied on published literature and took a lifetime, societal perspective.
  
  
  RESULTS
  Compared to current guidelines, incremental cost per quality-adjusted life year gained (ICER) was $7900 for general population screening and $4200 for screening by birth year, which dominated general population screening if cost, clinician uptake, and median age of diagnoses were assumed equivalent. General population screening remained cost-effective in all one-way sensitivity analyses, 30 000 Monte Carlo simulations, and scenarios in which background mortality was doubled, all genotype 1 patients were treated with protease inhibitors, and most parameters were set unfavorable to increased screening. ICER was lowest if screening was applied to a population with liver fibrosis similar to 2010 estimates. Approximately 1% of liver-related deaths would be averted per 15% of the general population screened; the impact would be greater with improved referral, treatment uptake, and cure.
  
  
  CONCLUSIONS
  Broader screening for HCV would likely be cost-effective, but significantly reducing HCV-related morbidity and mortality would also require improved rates of referral, treatment, and cure.
authors.affiliation: Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98104, USA. pcoffin@gmail.com
authors.forename: Phillip O
authors.initials: PO
authors.lastname: Coffin
authors.forename: John D
authors.initials: JD
authors.lastname: Scott
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Golden
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology* / Q000821:virology; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011480:Protease Inhibitors / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D011480:Protease Inhibitors