Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Feb 17;187(3):E110-E121.
doi: 10.1503/cmaj.140711. Epub 2015 Jan 12.

Cost-effectiveness of screening for hepatitis C in Canada

William W L Wong  1 , Hong-Anh Tu  2 , Jordan J Feld  2 , Tom Wong  2 , Murray Krahn  2
Affiliations

Cost-effectiveness of screening for hepatitis C in Canada

William W L Wong et al. CMAJ. .

Abstract

Background: The seroprevalence of hepatitis C virus (HCV) infection among Canadians is estimated at 0.3% to 0.9%. Of those with chronic HCV infection, 10% to 20% will experience advanced liver disease by 30 years of infection. Targeted screening seems a plausible strategy. We aimed to estimate the health and economic effects of various screening and treatment strategies for chronic HCV infection in Canada.

Methods: We used a state-transition model to examine the cost-effectiveness of 4 screening strategies: no screening; screen and treat with pegylated interferon plus ribavarin; screen and treat with pegylated interferon and ribavarin-based direct-acting antiviral agents; and screen and treat with interferon-free direct-acting antivirals. We considered Canadian residents in 2 age groups: 25-64 and 45-64 years of age. We obtained model data from the literature. We predicted deaths related to chronic HCV infection, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios.

Results: We found that screening and treating would prevent at least 9 HCV-related deaths per 10,000 persons screened over the lifetime of the cohort. Screening was associated with QALY increases of 0.0032 to 0.0095 and cost increases of $124 to $338 per person, which translated to an incremental cost-effectiveness ratio of $34,359 to $44,034 per QALY gained, relative to no screening, depending on age group screened and antiviral therapy received.

Interpretation: A selective one-time HCV screening program for people 25-64 or 45-64 years of age in Canada would likely be cost-effective. Identification of silent cases of chronic HCV infection and the offer of treatment when appropriate could extend the lives of Canadians at reasonable cost.

PubMed Disclaimer

Figures

Figure 1:
Figure 1:
State-transition model of hepatitis C virus (HCV) infection and progression. For more detail about sets of health states, see Appendix 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.140711/-/DC1). F1–F4 = fibrosis stages.
See this image and copyright information in PMC

References

    1. Kwong JC, Crowcroft NS, Campitelli MS, et al. Ontario burden of infectious disease study. Toronto: Institute for Clinical Evaluative Sciences; 2010.
    1. Shah HA, Heathcote EJ, Feld JJ. A Canadian screening program for hepatitis C: Is now the time? CMAJ 2013;185:1325–8. - PMC - PubMed
    1. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recomm Rep 2012;(RR-4):1–32. Erratum in: MMWR Recomm Rep 2012;61:886. - PubMed
    1. Asselah T, Marcellin P. Direct acting antivirals for the treatment of chronic hepatitis C: one pill a day for tomorrow. Liver Int 2012;32 Suppl 1:88–102. - PubMed
    1. Sherman M, Shafran S, Burak K, et al. Management of chronic hepatitis C: consensus guidelines. Can J Gastroenterol 2007;21 Suppl C:25C–34C. - PMC - PubMed

Publication types