Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis
Background & Aims: Approximately 10 million people live with chronic HCV infection in China, and less than 20% of people with HCV were diagnosed. We aim to determine the cost-effectiveness of one-time HCV screening compared with no screening in the Chinese population from the healthcare syst...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-04-01
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| Series: | JHEP Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555924000016 |
| _version_ | 1797220566460006400 |
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| author | Hua Zhou Mengxia Yan Datian Che Bin Wu |
| author_facet | Hua Zhou Mengxia Yan Datian Che Bin Wu |
| author_sort | Hua Zhou |
| collection | DOAJ |
| description | Background & Aims: Approximately 10 million people live with chronic HCV infection in China, and less than 20% of people with HCV were diagnosed. We aim to determine the cost-effectiveness of one-time HCV screening compared with no screening in the Chinese population from the healthcare system perspective. Methods: A decision-tree plus Markov model was adopted to project chronic hepatitis C (CHC) prevalence, probability of complications, quality-adjusted life years (QALYs), and costs in the Chinese general population undiagnosed for CHC for different screening strategies. Once CHC was diagnosed, pan-genotypic direct-acting antiviral agent treatment was administered regardless of fibrosis. The population was simulated in a model spanning a lifetime. Input parameters were obtained from published literature. The incremental cost-effectiveness ratio between screening and no screening was estimated. The one-time Chinese gross domestic product per capita in 2021 ($12,558/QALY) was used as the willingness-to-pay threshold. Results: Universal screening in the population aged 3–80 years led to the lowest probability of complications, which yielded a 62% reduction of excess mortality. Compared with no screening, implementing screening and treatment for HCV in populations aged 3–80 years resulted in the greatest marginal QALYs (15.2 per 1,000 population) with an increase in total costs of $109,136. Calculating the incremental cost-effectiveness ratio yields a value of $9,503/QALY (95% uncertainty interval $3,738–$22,566). The robustness of the model was demonstrated through various sensitivity analyses. If the CHC prevalence was over 0.3%, screening could be cost-effective. Conclusions: HCV screening for Chinese people aged 3–80 years may be a cost-effective intervention to reduce the disease burden related to HCV infection. This strategy should certainly be implemented. Impact and implications: This study found that screening Chinese people aged 3–80 years yielded the greatest health benefits and was a cost-effective alternative. The findings indicated that national efforts eliminating HCV should be invested and strengthened in China. The results of this study are important because they provide strong evidence that universal screening can be a cost-effective way to reduce the burden of HCV in China. These findings are important for policymakers, physicians, patients, caregivers, and the public because they promote awareness and inform decision-making for HCV prevention and treatment. |
| first_indexed | 2024-03-07T14:00:34Z |
| format | Article |
| id | doaj.art-e341eef98b394d47a4dcae28c0ac2b79 |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-04-24T12:51:35Z |
| publishDate | 2024-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JHEP Reports |
| spelling | doaj.art-e341eef98b394d47a4dcae28c0ac2b792024-04-06T04:40:23ZengElsevierJHEP Reports2589-55592024-04-0164101000Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysisHua Zhou0Mengxia Yan1Datian Che2Bin Wu3Department of VIP, Shanghai Children's Hospital, Affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaDepartment of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, ChinaDepartment of VIP, Shanghai Children's Hospital, Affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China; Corresponding authors. Addresses: Department of VIP, Shanghai Children’s Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China, 200040. Tel.: +86 21 6247 4880; Fax: +86 21 6247 4880 (D. Che); Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China, 200127. Tel.: +86 21 6838 3427; Fax: +86 21 6838 342 (B. Wu).Clinical Research Institute, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Corresponding authors. Addresses: Department of VIP, Shanghai Children’s Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China, 200040. Tel.: +86 21 6247 4880; Fax: +86 21 6247 4880 (D. Che); Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China, 200127. Tel.: +86 21 6838 3427; Fax: +86 21 6838 342 (B. Wu).Background & Aims: Approximately 10 million people live with chronic HCV infection in China, and less than 20% of people with HCV were diagnosed. We aim to determine the cost-effectiveness of one-time HCV screening compared with no screening in the Chinese population from the healthcare system perspective. Methods: A decision-tree plus Markov model was adopted to project chronic hepatitis C (CHC) prevalence, probability of complications, quality-adjusted life years (QALYs), and costs in the Chinese general population undiagnosed for CHC for different screening strategies. Once CHC was diagnosed, pan-genotypic direct-acting antiviral agent treatment was administered regardless of fibrosis. The population was simulated in a model spanning a lifetime. Input parameters were obtained from published literature. The incremental cost-effectiveness ratio between screening and no screening was estimated. The one-time Chinese gross domestic product per capita in 2021 ($12,558/QALY) was used as the willingness-to-pay threshold. Results: Universal screening in the population aged 3–80 years led to the lowest probability of complications, which yielded a 62% reduction of excess mortality. Compared with no screening, implementing screening and treatment for HCV in populations aged 3–80 years resulted in the greatest marginal QALYs (15.2 per 1,000 population) with an increase in total costs of $109,136. Calculating the incremental cost-effectiveness ratio yields a value of $9,503/QALY (95% uncertainty interval $3,738–$22,566). The robustness of the model was demonstrated through various sensitivity analyses. If the CHC prevalence was over 0.3%, screening could be cost-effective. Conclusions: HCV screening for Chinese people aged 3–80 years may be a cost-effective intervention to reduce the disease burden related to HCV infection. This strategy should certainly be implemented. Impact and implications: This study found that screening Chinese people aged 3–80 years yielded the greatest health benefits and was a cost-effective alternative. The findings indicated that national efforts eliminating HCV should be invested and strengthened in China. The results of this study are important because they provide strong evidence that universal screening can be a cost-effective way to reduce the burden of HCV in China. These findings are important for policymakers, physicians, patients, caregivers, and the public because they promote awareness and inform decision-making for HCV prevention and treatment.http://www.sciencedirect.com/science/article/pii/S2589555924000016Hepatitis C screeningsHealth outcomesEconomic evaluation |
| spellingShingle | Hua Zhou Mengxia Yan Datian Che Bin Wu Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis JHEP Reports Hepatitis C screenings Health outcomes Economic evaluation |
| title | Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis |
| title_full | Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis |
| title_fullStr | Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis |
| title_full_unstemmed | Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis |
| title_short | Universal screening for HCV infection in China: An effectiveness and cost-effectiveness analysis |
| title_sort | universal screening for hcv infection in china an effectiveness and cost effectiveness analysis |
| topic | Hepatitis C screenings Health outcomes Economic evaluation |
| url | http://www.sciencedirect.com/science/article/pii/S2589555924000016 |
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