title: Public health impact of comprehensive hepatitis C screening and treatment in the French baby-boomer population.
abstract: OBJECTIVE
  To estimate the public health impact of comprehensive hepatitis C virus (HCV) screening and access to all-oral, interferon (IFN)-free direct-acting antivirals (DAAs) in the French baby-boomer population (1945-1965 birth cohorts).
  
  
  METHODS
  A sequential, multi-cohort, health-state transition model was developed to assess the impact of different hepatitis C screening and treatment strategies on clinical and economic outcomes in the 1945-1965 birth cohorts. Patients newly-diagnosed with chronic HCV were projected each year from 2016 to 2036 under three screening scenarios (70% [low], 75% [intermediate], and 80% [high] HCV awareness in 2036). Healthcare costs and clinical outcomes (number of liver-related deaths, quality-adjusted life-years [QALYs], life-years [LYs] spent in sustained virologic response [SVR] or with decompensated cirrhosis, hepatocellular carcinoma, or liver transplant) were compared among five treatment strategies (no antiviral therapy; IFN + ribavirin + protease inhibitor for fibrosis stages F2-F4, IFN-based DAAs for stages F2-F4, IFN-free DAAs for stages F2-F4, and IFN-free DAAs for stages F0-F4).
  
  
  RESULTS
  Diagnosis of HCV genotype 1 was projected for 4,953, 6,600, and 8,368 individuals in the low, intermediate, and high screening scenarios, respectively. In the intermediate scenario, IFN-free DAAs for stages F0-F4 had a favorable cost-effectiveness profile vs IFN-based or IFN-free treatment strategies for F2-F4 and offered the greatest return on investment (0.899 LYs gained in SVR and 0.933 QALYs per €10,000 invested).
  
  
  CONCLUSIONS
  Comprehensive HCV screening and access to all-oral, IFN-free DAAs is a cost-effective strategy that could help diminish the upcoming burden of HCV in the French baby-boomer population.
authors: a SERFAN innovation , Namur , Belgium.|b University of Liège , Liège , Belgium.
authors: Olivier
authors: O
authors: Ethgen
authors: c AbbVie Inc. , North Chicago , IL , USA.
authors: Yuri
authors: Y
authors: Sanchez Gonzalez
authors: c AbbVie Inc. , North Chicago , IL , USA.
authors: Grégoire
authors: G
authors: Jeanblanc
authors: c AbbVie Inc. , North Chicago , IL , USA.
authors: Aurore
authors: A
authors: Duguet
authors: c AbbVie Inc. , North Chicago , IL , USA.
authors: Derek
authors: D
authors: Misurski
authors: c AbbVie Inc. , North Chicago , IL , USA.
authors: Timothy
authors: T
authors: Juday
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics*; D005602:France; D016174:Hepacivirus / Q000302:isolation & purification; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011634:Public Health; D012254:Ribavirin / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin
keywords: France; Hepatitis C; Public health impact; Screening; Treatment