Cost-effectiveness of Universal and Targeted Hepatitis C Virus Screening in the United States

Importance Between 2 and 3.5 million people live with chronic hepatitis C virus (HCV) infection in the US, most of whom (approximately 75%) are not aware of their disease. Despite the availability of effective HCV treatment in the early stages of infection, HCV will result in thousands of deaths in the next decade in the US. Objective To investigate the cost-effectiveness of universal screening for all US adults aged 18 years or older for HCV in the US and of targeted screening of people who inject drugs. Design, Setting, and Participants This simulated economic evaluation used cohort analyses in a Markov model to perform a 10000-participant Monte Carlo microsimulation trail to evaluate the cost-effectiveness of HCV screening programs, and compared screening programs targeting people who inject drugs with universal screening of US adults age 18 years or older. Data were analyzed in December 2019. Exposures Cost per quality-adjusted life-year (QALY). Main Outcomes and Measures Cost per QALY gained. Results In a 10000 Monte Carlo microsimulation trail that compared a baseline of individuals aged 40 years (men and women) and people who inject drugs in the US, screening and treatment for HCV were estimated to increase total costs by $10457 per person and increase QALYs by 0.23 (approximately 3 months), providing an incremental cost-effectiveness ratio of $45465 per QALY. Also, universal screening and treatment for HCV are estimated to increase total costs by $2845 per person and increase QALYs by 0.01, providing an incremental cost-effectiveness ratio of $291277 per QALY. Conclusions and Relevance The findings of this study suggest that HCV screening for people who inject drugs may be a cost-effective intervention to combat HCV infection in the US, which could potentially decrease the risk of untreated HCV infection and liver-related mortality. This economic evaluation analyzes the cost-effectiveness of 2 hepatitis C screening programs, a program targeting people who inject drugs and a universal program for US adults, and compares outcomes with the status quo in a Monte Carlo microsimulation. Question Are universal hepatitis C virus (HCV) screening for all US adults aged 18 years or older and targeted HCV screening among people who inject drugs cost-effective for limiting HCV infection? Findings In this economic evaluation study, HCV screening for people who inject drugs in the US increased quality-adjusted life-years (QALYs) by 0.23 (ie, approximately 3 months), with an incremental cost-effectiveness ratio of $45465 per QALY. Universal HCV screening increased QALY overall by 0.01, with an incremental cost-effectiveness ratio of $291277 per QALY. Meaning The findings of this study suggest that HCV screening for people who inject drugs may be a cost-effective intervention to combat HCV infection, which would decrease the risk of untreated HCV infection and liver-related mortality.