Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis

Sex-related differences in patients with chronic hepatitis C infection treated with direct-acting antiviral drugs

BACKGROUND

Sex is one of the known factors influencing the risk of hepatitis C virus (HCV) infection and the natural course of the disease.

AIM

To evaluate sex-related differences in the characteristics and outcomes of direct-acting antiviral (DAA) treatment in HCV-infected patients.

METHODS

The study included consecutive 9457 women and 9529 men, treated with DAA for chronic HCV infection from July 2015 to the end of 2023 whose data were collected in the nationwide multicenter retrospective Epiter-2 project. Women were divided into pre-menopausal (15-44 years), menopausal (45-55 years) and post-menopausal (> 55 years) and compared with age-matched men.

RESULTS

Regardless of age, women had a significantly lower body mass index, prevalence of genotype 3 infection and proportion of cirrhosis compared to men. Psychiatric disorders (except depression), hepatitis B virus and human immunodeficiency virus co-infections, as well as alcohol and drug addiction, were significantly less common in women than in men in all age groups. The sustained virologic response was significantly higher in women compared to men in each age group and amounted to 98.4% and 96.6%, respectively (P < 0.001). Independent predictors of treatment failure in women were genotype 3 infection, cirrhosis and postmenopausal age. Mild adverse events were reported significantly more often by women, regardless of age with the highest percentage in the postmenopausal group.

CONCLUSION

DAA treatment is more effective in women than in men, regardless of age, but in postmenopausal women, the effectiveness is relatively the lowest.

Universal HCV Screening in Hospitalised Patients in France: It Could Be a Good Option! The DEVICHO Study

In France, chronic hepatitis C whatever fibrosis stage or comorbidities can be freely treated by any physician. However, screening is still currently based on risk factors, and universal screening remains controversial. The aims of this prospective DEVICHO study were to assess the value of universal screening in hospitalised patients, to evaluate the prevalence of HCV infection and to compare the short-term cost and benefit of this strategy with routine screening. From November 2019 to November 2021, all hospitalised patients from 22 departments were asked by their physicians to be tested for HCV. 4986/25,663 (19.4%) in the DEVICHO study (Group 1) and 1803 patients (7%) outside the study (Group 2) were screened. HCV screening rate varied widely (0%-75.1%) between departments. One hundred and ninety-nine patients (2.9%) were HCV-Ab positive. 29/199 HCV-Ab positive patients (14.6%) or 29/6789 patients tested (0.4%) were HCV-RNA positive. Among the 29 viremic patients, 9 (31%) were treated, all achieving sustained virological response, but two patients died rapidly after treatment. Seventeen patients died untreated within a year of diagnosis, and three patients were not treated. Universal screening compared to routine practice would be more expensive and more effective, resulting in an additional cost of €11,060 per HCV RNA infection identified and €36,600 per HCV cure, both below the GDP per capita of France (€38,000, Eurostat 2023). Even if the population screened is older, often with significant comorbidities, hospital-based HCV screening is efficient because its prevalence is higher in hospitalised patients than in the general population. Additionally, this screening strategy appears to be cost effective. However, healthcare professionals and insufficient linkage to care are the main barriers to screening. Trial Registration: ClinicalTrials.gov identifier: NTC 04437277.

The macroeconomic burden of hepatitis C and the economic benefit of accelerated investments in China

BACKGROUND

Hepatitis C virus (HCV) poses a significant health and economic burden worldwide, with China bearing a considerable portion of this burden. Chinese treatment coverage remains low, and the full economic implications of achieving these goals are not well understood.

OBJECTIVE

This study aims to evaluate the macroeconomic burden of HCV from 2023 to 2050, as well as the investments required, health benefits, cost-effectiveness, net economic benefit, and the impact on economic growth associated with achieving WHO hepatitis C intervention coverage targets more rapidly during this period.

METHODS

A dynamic compartmental model was used to simulate the transmission, progression, and cascade of care for HCV patients in China. Intervention costs and healthcare costs were calculated using the cost-of-illness (COI) method. A health-augmented macroeconomic model projected macroeconomic outcomes. Scenarios were developed to evaluate different time points for achieving coverage targets.

RESULTS

The projected macroeconomic burden of HCV from 2023 to 2050 is $1.17 trillion. Achieving WHO targets by 2030 is expected to spend $69.72 (95% UI $66.22-$73.68) billion but will avert 0.66(95% UI 0.58-0.74) million hepatocellular carcinoma (HCC) cases, and 1.10(95% UI 1.03-1.18) million HCV-related deaths compared to status quo. Faster achievement of coverage targets is associated with investments becoming cost-effective sooner and facilitating greater economic growth.

CONCLUSION

Achieving the WHO Global Health Sector Strategy diagnosis and treatment coverage targets by 2030 in China is projected to be cost-effective and result in significant health and economic benefits. The findings underscore the importance of increased investment in hepatitis C elimination efforts in China.

Cost-Effectiveness of Screening and Treating Chronic Hepatitis C Virus Infection in Zimbabwe

BACKGROUND

The aim of this study was to assess the cost effectiveness of a screening and treatment intervention approach for chronic HCV infection in Zimbabwe.

METHODS

Using a decision tree and a validated Markov model, we estimated the lifetime costs and health effects of screening for and treating HCV infections from a healthcare perspective. We evaluated three screening strategies, namely the following: i. no screening; ii. screening among the general population; and iii. screening among high-risk groups. Incremental cost effectiveness ratios were calculated for the strategies that were not dominated. We used deterministic and probabilistic sensitivity analyses to explore the impacts of parameter uncertainty on cost effectiveness outcomes.

RESULTS

The strategy of screening among high-risk groups and treating with sofosbuvir/velpatasvir had an incremental cost of USD 1201 and incremental quality-adjusted life years (QALY) of 2.01, yielding an incremental cost effectiveness ratio (ICER) of USD 604 per QALY gained as compared to no screening. The ICER was below the 0.5 times the gross domestic product per capita parameter (USD 796), making the intervention potentially cost effective. The strategy to screen among the general population was dominated, because it costed more and resulted in fewer QALYs than its comparators.

CONCLUSIONS

Screening for HCV among high-risk populations followed by treatment using sofosbuvir/velpatasvir is cost effective under the assumptions made in this study.

Self-testing strategy to eliminate hepatitis C as per World Health Organization's goal: Analysis of disease burden and cost-effectiveness

BACKGROUND/AIMS

The World Health Organization (WHO) aims to eliminate hepatitis C virus (HCV) by 2030; therefore, widespread HCV screening is required. The WHO recommends HCV self-testing (HCVST) as a new approach. We aimed to evaluate disease burden reduction using the HCVST screening strategy and identify the most cost-effective approach.

METHODS

We developed a dynamic open-cohort Markov model to assess the long-term effects and costeffectiveness of HCVST in the Republic of Korea from 2024 to 2030. Strategies for comparison included universal, birth cohort, high-risk group screening, and no screening, focusing on the following: (1) incremental costeffectiveness ratio (ICER) per disability-adjusted life-year (DALY) saved; (2) severe liver disease cases; and (3) liverrelated death reduction.

RESULTS

Universal HCVST screening is the most effective strategy for achieving the WHO goal by 2030, substantially lowering the incidence of severe liver disease by 71% and preventing liver-related deaths by 69%, thereby averting 267,942 DALYs. Moreover, with an ICER of US$8,078 per DALY and high cost-effectiveness, the sensitivity results prove that cost-effectiveness is robust. Although high-risk group screening offers the lowest cost compared with other strategies, its effectiveness in preventing severe liver disease is minimal, falling short of the current WHO goal.

CONCLUSION

Our study confirms that universal HCVST screening is a cost-effective strategy aligned with the WHO goal to eliminate HCV by 2030. Despite its higher costs compared to risk-based screening, the disease burden can be significantly reduced by providing effective HCVST access to individuals who might otherwise not be tested.

A cost analysis of a simplified model for HCV screening and treatment at a tertiary hospital in Zimbabwe

BACKGROUND

The treatment of chronic hepatitis C virus (HCV) infection using directly acting antivirals was recently adopted in the treatment guidelines of Zimbabwe. The objectives of this study were to design a simplified model of HCV care and estimate the cost of screening and treatment of hepatitis C infection at a tertiary hospital in Zimbabwe.

METHODS

We developed a model of care for HCV using WHO 2018 guidelines for the treatment of HCV infection and expert opinion. We then performed a micro-costing to estimate the costs of implementing the model of care from the healthcare sector perspective. Deterministic and probabilistic sensitivity analyses were performed to explore the impact of uncertainty in input parameters on the estimated total cost of care.

RESULTS

The total cost of screening and treatment was estimated to be US$2448 (SD=$290) per patient over a 12-week treatment duration using sofosbuvir/velpatasvir. The cost of directly acting antivirals contributed 57.5% to the total cost of care. The second largest cost driver was the cost of diagnosis, US$819, contributing 34.6% to the total cost of care.

CONCLUSION

Screening and treatment of HCV-infected individuals using directly acting antivirals at a tertiary hospital in Zimbabwe may require substantial financial resources.