Value of expanding HCV screening and treatment policies in the United States.
OBJECTIVE
To investigate the value of expanding screening and treatment for hepatitis C virus (HCV) infection in the United States.


METHODS
Discrete-time Markov model.


METHODS
We modeled HCV progression and transmission to analyze the costs and benefits of investment in screening and treatment over a 20-year time horizon. Population-level parameters were estimated using National Health and Nutrition Examination Survey data and published literature. We considered 3 screening scenarios that vary in terms of clinical guidelines and physician awareness of guidelines. For each screening scenario, we modeled 3 approaches to treatment, varying the fibrosis stage of treatment initiation. Net social value was the key model outcome, calculated as the value of benefits from improved quality-adjusted survival and reduced transmission minus screening, treatment, and medical costs.


RESULTS
Expanded screening policies generated the largest value to society. However, this value is constrained by the availability of treatment to diagnosed patients. Screening all individuals in the population generates $0.68 billion in social value if diagnosed patients are treated in fibrosis stages F3-F4 compared with $824 billion if all diagnosed patients in stages F0-F4 are treated. Moreover, increased screening generates cumulative net social value by year 8 to 9 under expanded treatment policies compared with 20 years if only patients in stages F3-F4 are treated.


CONCLUSIONS
Although increasing screening for HCV may generate some value to society, only when paired with expanded access to treatment at earlier disease stages will it produce considerable value. Such a "test and treat" strategy is likely to entail higher short-term costs but also yield the greatest social benefits.
Precision Health Economics, 11100 Santa Monica Blvd, Suite 500, Los Angeles, CA 90025. E-mail: mark.linthicum@precisionhealtheconomics.com.
Mark T
MT
Linthicum
Yuri Sanchez
YS
Gonzalez
Karen
K
Mulligan
Gigi A
GA
Moreno
David
D
Dreyfus
Timothy
T
Juday
Steven E
SE
Marx
Darius N
DN
Lakdawalla
Brian R
BR
Edlin
Ron
R
Brookmeyer
D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D016527:Drug Costs; D042241:Early Diagnosis; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000635:transmission; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D018803:Models, Economic; D009749:Nutrition Surveys / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years; D012945:Social Values; D014481:United States
D000998:Antiviral Agents