The emergency department as a setting‐specific opportunity for population‐based hepatitis C screening: An economic evaluation. (30th April 2020)

• Record Type: Journal Article
• Authors: Mendlowitz, Andrew B.; Naimark, David; Wong, William W. L.; Capraru, Camelia; Feld, Jordan J.; Isaranuwatchai, Wanrudee; Krahn, Murray
• Is Part Of: Liver international. Volume 40:Number 6(2020)
• Page Start: 1282
• Page End: 1291
• Publication Date: 2020-04-30
• Subjects: cost‐utility analysis -- economic evaluation -- emergency department -- hepatitis C -- screening; Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.14458
• Languages: English
• ISSNs: 1478-3223

Abstract

Abstract: Background and Aims: The World Health Organization's hepatitis C virus (HCV) elimination strategy recognizes the need for interventions that identify populations most affected by infection. The emergency department (ED) has been suggested as a setting for HCV screening. The study objective was to explore the health and economic impact of HCV screening in the ED setting. Methods: We used a microsimulation model to conduct a cost‐utility analysis evaluating two ED setting‐specific strategies: no screening, and screening and subsequent treatment. Strategies were examined for two populations: (a) the general ED patient population; and (b) ED patients born between 1945 and 1975. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon. A reference and high ED HCV seroprevalence measure were examined in the Canadian healthcare setting.US costs of chronic infection were used for a scenario analysis of screening in the US healthcare setting. Results: For birth cohort screening, in comparison to no screening, one liver‐related death was averted for every 760 and 123 persons screened for the reference and high seroprevalence measures. For general population screening, one liver‐related death was averted for every 831 and 147 persons screened for the reference and high seroprevalence measures. In comparison to no screening, birth cohort screening was cost‐effective at CAN$25, 584/quality‐adjusted life year (QALY) and US$42, 615/QALY. General population screening was cost‐effective at CAN$19, 733/QALY and US$32, 187/QALY. Conclusions: ED screening may represent a cost‐effective component of population‐based strategies to eliminate HCV. Further studies are warranted to explore the feasibility and acceptability of this approach.