Dataset Information

Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis.

ABSTRACT:

Objective

Screening for hepatitis C in Russia is a complex process that involves several visits and stepwise testing, limiting adherence and substantially reducing the yield in the identification of active infections. We aimed to evaluate the cost-effectiveness of different screening algorithms from a health system perspective.

Methods

A decision analytic model was applied to a hypothetical adult population eligible to participate in a general screening program for hepatitis C in Russia. The standard pathway (I: Screen for anti-HCV antibodies followed by a nucleic acid test for HCV RNA on antibody positives) was compared to three alternatives (II: Screen for antibodies, a reflexed test for HCV antigen on antibody positives, and RNA on antigen negatives; III: Screen for antibodies, a reflexed test for HCV antigen on antibody positives; IV: Screen for antigen). Each strategy considered a cascade of events (referral, adherence, testing, diagnosis) that must occur for screening to be effective. The primary measure of effectiveness was the number of diagnosed active infections. Calculations followed a health system perspective with costs derived from 2017 reimbursement rates and a willingness-to-pay of 2,000RUB ($82) per diagnosed active infection. Model was tested with deterministic and probabilistic sensitivity analyses.

Results

Non-adherence to screening stages reduced the capture rate of active infections in Strategy I from 79.0% to 40.6%. Strategies II, III, and IV were less affected and identified 69%, 67%, and 104% more infections. Average costs per diagnosed infection were decreased by 41% from 89,599RUB ($3,681) for I to 53,072RUB ($2,180), 53,004RUB ($2,177), and 59,633RUB ($2,450) for II, III, and IV, respectively. With a probability of 97%, Strategy III was most cost-effective with an incremental cost-effectiveness ratio vs. I of -1,373RUB (CI: -5,011RUB to -2,033RUB; $-56; CI: -$206 to -$84). Below a willingness-to-pay of 91,000RUB ($3,738), Strategy IV was not cost-effective. Sensitivity analyses confirmed the robustness of results.

Conclusions

Testing strategies for hepatitis C with HCV antigen on HCV antibody positive cases offer a streamlining opportunity for population screening programs. Those shall increase the chances for detecting active infections and are cost-effective over current practice in Russia.

SUBMITTER: Julicher P

PROVIDER: S-EPMC6634401 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Publications

Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis.

Jülicher Paul P Chulanov Vladimir P VP Pimenov Nikolay N NN Chirkova Ekaterina E Yankina Anna A Galli Claudio C

PloS one 20190716 7

<h4>Objective</h4>Screening for hepatitis C in Russia is a complex process that involves several visits and stepwise testing, limiting adherence and substantially reducing the yield in the identification of active infections. We aimed to evaluate the cost-effectiveness of different screening algorithms from a health system perspective.<h4>Methods</h4>A decision analytic model was applied to a hypothetical adult population eligible to participate in a general screening program for hepatitis C in ...[more]

PMID: 31310636

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Dataset Information

Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis.

Objective

Methods

Results

Conclusions

Publications

Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis.

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