title: Economic assessment of an anti-HCV screening program in Italy.
abstract: BACKGROUND
  The progression of hepatitis C virus (HCV) disease usually occurs over a 10-year period. HCV-related complications as well as the highly debilitating effects on patients represent a significant item of expenditure for the National Health Service. Early detection of HCV infection is an excellent opportunity to improve patients' quality of life and to rationalize resource allocation.
  
  
  OBJECTIVE
  The aim of this study was to provide a cost-effectiveness evaluation of an anti-HCV screening program in the Italian National Health Service perspective.
  
  
  METHODS
  We built a Markov model made up of two arms. The ''Test Strategy'' arm involves a screening program based on the enzyme immunoassay for detection of antibodies as first-level test and the research of HCV RNA as second-level detection; patients with positive test results are treated with peg-interferon alfa in combination with ribavirine. Parameters were derived from the literature and validated through experts' opinion. Costs and benefits were discounted by 3.5%. Results were expressed as cost/quality-adjusted life-year (QALY) gained through the screening program compared with the treatment of symptomatic patients. Deterministic and probabilistic sensitivity analysis was performed.
  
  
  RESULTS
  The incremental cost-effectiveness ratio of the ''Test Strategy'' is €5171/QALY, definitively below the cost/QALY of other approved treatments in Italy. Model results turned out as sensitive to the age of the target population, the prevalence of HCV infection, and the time horizon adopted.
  
  
  CONCLUSIONS
  The anti-HCV screening program is a valid health-related investment improving patients' quality of life and survival with an acceptable expenditure increase for the National Health Service.
authors.affiliation: Faculty of Economics, Catholic University of Sacred Heart, Rome, Italy. Electronic address: mruggeri@rm.unicatt.it.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ruggeri
authors.forename: Silvia
authors.initials: S
authors.lastname: Coretti
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Americo
authors.initials: A
authors.lastname: Cicchetti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005838:Genotype; D006295:Health Resources / Q000191:economics; D016174:Hepacivirus / Q000276:immunology*; D018937:Hepatitis C Antibodies / Q000097:blood*; D019698:Hepatitis C, Chronic / Q000175:diagnosis*; D006801:Humans; D007558:Italy; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D009010:Monte Carlo Method; D009313:National Health Programs; D055815:Young Adult
chemical_list: D018937:Hepatitis C Antibodies
keywords: Italy; Markov model; cost-effectiveness; liver disease