title: Cost-effectiveness of screening for hepatitis C in Canada.
abstract: BACKGROUND
  The seroprevalence of hepatitis C virus (HCV) infection among Canadians is estimated at 0.3% to 0.9%. Of those with chronic HCV infection, 10% to 20% will experience advanced liver disease by 30 years of infection. Targeted screening seems a plausible strategy. We aimed to estimate the health and economic effects of various screening and treatment strategies for chronic HCV infection in Canada.
  
  
  METHODS
  We used a state-transition model to examine the cost-effectiveness of 4 screening strategies: no screening; screen and treat with pegylated interferon plus ribavarin; screen and treat with pegylated interferon and ribavarin-based direct-acting antiviral agents; and screen and treat with interferon-free direct-acting antivirals. We considered Canadian residents in 2 age groups: 25-64 and 45-64 years of age. We obtained model data from the literature. We predicted deaths related to chronic HCV infection, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios.
  
  
  RESULTS
  We found that screening and treating would prevent at least 9 HCV-related deaths per 10,000 persons screened over the lifetime of the cohort. Screening was associated with QALY increases of 0.0032 to 0.0095 and cost increases of $124 to $338 per person, which translated to an incremental cost-effectiveness ratio of $34,359 to $44,034 per QALY gained, relative to no screening, depending on age group screened and antiviral therapy received.
  
  
  CONCLUSIONS
  A selective one-time HCV screening program for people 25-64 or 45-64 years of age in Canada would likely be cost-effective. Identification of silent cases of chronic HCV infection and the offer of treatment when appropriate could extend the lives of Canadians at reasonable cost.
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont. william.wong@theta.utoronto.ca.
authors.forename: William W L
authors.initials: WWL
authors.lastname: Wong
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont.
authors.forename: Hong-Anh
authors.initials: HA
authors.lastname: Tu
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont.
authors.forename: Jordan J
authors.initials: JJ
authors.lastname: Feld
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont.
authors.forename: Tom
authors.initials: T
authors.lastname: Wong
authors.affiliation: Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy (W. Wong, Krahn), and Institute of Health Policy, Management and Evaluation (Tu), University of Toronto, Toronto, Ont.; Toronto Centre for Liver Disease, University Health Network (Feld), Toronto, Ont.; Public Health Agency of Canada (T. Wong), Ottawa, Ont.
authors.forename: Murray
authors.initials: M
authors.lastname: Krahn
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D002170:Canada; D003362:Cost-Benefit Analysis; D005260:Female; D019698:Hepatitis C, Chronic / Q000191:economics / Q000517:prevention & control*; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012254:Ribavirin / Q000008:administration & dosage
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D012254:Ribavirin