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Estimating the cost‐effectiveness of screening for hepatitis C virus infection in Japan
Author(s) -
Nagai Kota,
Ide Kazuki,
Kawasaki Yohei,
TanakaMizuno Sachiko,
Seto Kahori,
Iwane Shinji,
Eguchi Yuichiro,
Kawakami Koji
Publication year - 2020
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.13478
Subject(s) - medicine , population , cost effectiveness , referral , hepatitis c virus , quality adjusted life year , ribavirin , cost effectiveness analysis , hepatitis c , immunology , virus , family medicine , environmental health , risk analysis (engineering)
Aim The management of hepatitis C virus (HCV) has changed with the advent of interferon (IFN)‐free treatment and the declining prevalence of HCV infection, which may impact the cost‐effectiveness of the screening. We aimed to compare the cost‐effectiveness and clinical outcomes of three screening strategies in the Japanese general population: no screening, screening plus IFN‐based therapy, and screening plus IFN‐free therapy. Methods We developed a decision analytic Markov model for screening intervention and natural history of HCV. Model parameters were derived from published literature. A lifetime horizon and the healthcare payer perspective were taken. Subanalyses included high screening scenario with improved rates of screening and attending referral, in addition to heterogeneity analysis by age subgroup. Results In the base case, the incremental cost‐effectiveness ratio in the Japanese general population aged 40–89 years was ¥1 124 482 and ¥1 085 183 per quality‐adjusted life year gained for screening plus IFN‐free therapy compared with no screening and screening plus IFN‐based therapy, respectively. Screening plus IFN‐free therapy remained cost‐effective below ¥5 000 000 per quality‐adjusted life year gained in sensitivity analyses. Incremental cost‐effectiveness ratios were lower in the younger population. Nearly 0.2% of HCV‐related deaths were avoided by 1.5% of the general population screened followed by IFN‐free therapy relative to no screening; the impact was greater with improved rates of screening and attending referral. Conclusions Screening and subsequent IFN‐free therapy for HCV appears to be cost‐effective. Early diagnosis and treatment would produce a favorable incremental cost‐effectiveness ratio. Improved rates of screening and attending referral would result in further reduction of disease progression.