A province-by-province cost-effectiveness analysis and budget impact analysis of one-time birth cohort screening of hepatitis C virus (HCV) infection in Canada.

Autor: Wong WWL; School of Pharmacy, Faculty of Science, University of Waterloo, PHR4011, 10A Victoria Street S, Kitchener, ON, N2G1C5, Canada. wwlwong@uwaterloo.ca.; Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada. wwlwong@uwaterloo.ca.; ICES, Toronto, ON, Canada. wwlwong@uwaterloo.ca., Haines A; Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada., Wong J; Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada., Hamadeh A; School of Pharmacy, Faculty of Science, University of Waterloo, PHR4011, 10A Victoria Street S, Kitchener, ON, N2G1C5, Canada., Krahn MD; Toronto Health Economics and Technology Assessment Collaborative (THETA), University Health Network, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2023 Aug 18; Vol. 13 (1), pp. 13484. Date of Electronic Publication: 2023 Aug 18.
DOI: 10.1038/s41598-023-39521-8
Abstrakt: Managing chronic hepatitis C is challenging, as the majority of those infected are asymptomatic. Therefore, to ensure treatments are administered before the onset of severe complications, screening is important. In Canada, uncertainty regarding the cost-effectiveness and budget impact of screening has led to conflicting recommendations. The objective of this study is to estimate the cost-effectiveness and budget-impact of one-time HCV screening. A state-transition model was developed to evaluate the cost-effectiveness and budget-impact between a risk-based screening strategy (current-practice) and a one-time screening strategy on three different birth-cohorts. Cost and prevalence data were obtained from administrative data. Progression and utility data were based on recent systematic reviews. We used a provincial payer-perspective, life-time time-horizon and a 1.5% discount rate for the cost-effectiveness analysis, and used a 10-year time-horizon and no discounting for the budget-impact analysis. One-time screening strategy would cost more and provide more health benefits than the risk-based screening for all birth cohorts. For those born after 1964, the incremental-cost-effectiveness-ratio (ICER) per quality-adjusted-life-year (QALY) of screening versus current-practice varied from $27,422/QALY to $42,191/QALY across different provinces. One-time screening of the cohort would cost an additional $2 million to $236 million across different provinces. For those born 1945-1964, the ICER of screening versus current-practice varied from $35,217/QALY to $48,197/QALY across different provinces. For the cohort born before 1945, the ICER of screening versus current-practice was not cost-effective at a willingness-to-pay threshold of $50,000/QALY across all provinces. Our cost-effectiveness analysis suggests that a one-time HCV screening program for those born after 1945 is cost-effective. Considering the budget impact relative to other funded recommended health services and technologies, HCV screening could be considered affordable.
(© 2023. Springer Nature Limited.)
Databáze: MEDLINE
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