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Best PracticeIntervention Sroczynski G et al (2010) Long-term effectiveness and cost-effectiveness of antiviral treatment in hepatitis C Journal of Viral Hepatitis 17(1)34-50

Date of Review March 23 2015

Reviewer(s) Christine Hu

Part A

Category Basic Science Clinical Science Public HealthEpidemiology

Social Science Programmatic Review

Best PracticeIntervention Focus Hepatitis C Hepatitis CHIV Other

Level Group Individual Other

Target Population HCV patients

Setting Health care settingClinic Home Other

Country of Origin Australia

Language English French Other

Part B

YES NO NA COMMENTS

Is the best practiceintervention a meta-analysis or primary research

Systematic review to assess the long-term effectiveness and cost-effectiveness of hepatitis C screening in different populations

Has the datainformation been used for decision-making (eg program funding developments policies treatment guidelines defining research priorities and funding)

Findings were not used for decision-making

Do the methodologyresults described allow the reviewer(s) to assess the generalizability of the results

Results cannot be generalized given the different epidemiology health care systems disease management practice patterns and treatment costs in different countries

Criteria Grid Hepatitis C Research Studies Tools and Surveillance Systems

Are the best practicesmethodologyresults described applicable in developed countries

Similar cost-effectiveness systematic review can be done However results cannot be generalized to various countries because of treatment costs differences and HCV management screening and treatment

YES NO NA COMMENTS

Are the best practicesmethodologyresults described applicable in developing countries

Studies included in this review originate only from European countries and USA

The research studytooldata dictionary is easily accessedavailable electronically

Purchase required for access at httponlinelibrarywileycom

Is there evidence of cost effective analysis with regard to interventions diagnosis treatment or surveillance methodologies If so what does the evidence say Please go to Comments section

Seven cost-effectiveness studies included in this review

- Incremental cost-effectiveness ratios (ICER) varied depending on the target population study perspective time horizon discount rate and compared strategies

- ICER of HCV screening vs no screening varied from 18300 to 1151000 euroQALY

- Screening in blood recipients not cost-effective given ICER over 140600 euroQALY

- HCV screening was considered cost-effective (ICURs below 40000 euroQALY for treatment with peg-IFN plus RBV) in populations with an elevated HCV prevalence such as intravenous drug users

Are there increased costs (infrastructure manpower skillstraining analysis of data) to using the research studytooldata dictionary

How is the research studytool funded Please got to Comments section

This study was supported in part by Hoffmann La-Roche Ltd Basel Switzerland

Is the best practiceintervention dependent on external funds

Other relevant criteria

Long-term effectiveness

- 5 out of 7 cost-effectiveness studies shown undiscounted life years andor quality-adjusted life years gained for screening and early treatment for HCV compared to no screening and standard care

- Depending on HCV prevalence and risk selection mode the long-term effectiveness of HCV varied from 00004 LYG (015 life-days gained) to 0066 LYG (24 life-days gained) and from 00001 QALY (004 quality adjusted life-days gained) to 0072 QALY (26 quality-adjusted life-days gained)

WITHIN THE SURVEILLANCE SYSTEM FOR REVIEW

Are these data regularly collected

Literature search was limited to March 2007

Are these data regularly collected at andor below a national level

Are these data collected manually or electronically

Electronically searched using databases Medline Cochrane Database of Systematic Reviews Cochrane central register of controlled trials and the NHS databases abstracts of reviews of effects Health technology assessment and Economic evaluation database

RESEARCH REPORTS

Has this research been published in a juried journal

Journal of Viral Hepatitis

Does the evidence utilize the existing datasurveillance information or has it generated new data andor information

Existing data included Health Technology Assessment (HTA) reports systematic reviews long-term clinical trials full health economic and decision-analytic modeling studies

Long-term effectiveness and cost-effectivenessof screening for Hepatitis C virus infection

Gaby Sroczynski1 Eva Esteban1 Annette Conrads-Frank12 Ruth Schwarzer1Nikolai Muhlberger1 Davene Wright2 Stefan Zeuzem3 Uwe Siebert124

Background Hepatitis C virus (HCV) infection is an emerging problem in public health In mostcountries the majority of HCV infected people are yet undiagnosed Early detection and treatmentmay result in better health outcomes and save costs by preventing future advanced liver disease Theevidence for long-term effectiveness and cost-effectiveness of HCV screening was systematicallyreviewed Methods We performed a systematic literature search on long-term health-economic effectsof HCV screening and included Health Technology Assessment (HTA) reports systematic reviewslong-term clinical trials full health economic and decision-analytic modelling studies with a sufficientlylong time horizon and patient-relevant long-term outcomes such as life-years gained (LYG) or quality-adjusted life years (QALY) gained Economic results were converted to 2005 Euros Results Seven studieswere included Target population HCV prevalence study perspective discount rate screening andantiviral treatment mode varied The incremental effectiveness of HCV screening and early treatmentcompared to no screening and standard care varied from 00004 to 0066 LYG and from 00001 to 0072QALY Incremental cost-effectiveness and cost-utility ratios of HCV screening vs no screening were3900ndash243 700ELYG and 18 300ndash1 151 000EQALY HCV screening seems to be cost-effective inpopulations with high HCV prevalence but not in low HCV prevalence populations Conclusions HCVscreening and early treatment have the potential to improve average life-expectancy but should focuson populations with elevated HCV prevalence to be cost-effective Further research on the long-termhealth-economic impact of HCV screening when combined with appropriate monitoring strategiesin different European health care systems is needed

Keywords chronic hepatitis C cost effectiveness screening

Introduction

Chronic Hepatitis C (CHC) is an emerging problem inpublic health In Europe the Hepatitis C virus (HCV)

infection affects gt 1 of the population with a HCV-incidenceof 86100 00012 HCV prevalence differs considerably acrosscountries and risk groups3 The highest HCV prevalence(36ndash81) is currently found in intravenous drug users(IDUs)1

The majority of HCV-infected people progress to chronicdisease4 Approximately 15ndash20 of CHC cases developcirrhosis within 20ndash30 years5ndash12 which is associated with ahigh risk for advanced liver disease quality of life impairmentreduced life expectancy and high treatment costs CHC isconsidered to be the leading cause of liver cancer and livertransplantation in Europe13

Screening for CHC clearly fulfils the general criteriafor population screening1415 and may help to identify

HCV-infected patients in an early stage of the disease(eg mild chronic hepatitis without fibrosis) so that theycan be adequately monitored and treated Moreover it hasbeen reported that it may be cost-effective to treat patientsdiagnosed with mild disease1617 Furthermore for the majorityof acute HCV cases which present no symptoms earlytreatment and for symptomatic acute HCV cases watchfulwaiting may be currently the most effective and cost-effectivestrategies18 Thus early detection and early treatment mayhave the potential to result in better health outcomes and tosave costs by preventing future advanced liver disease Anotherimportant reason to identify unaware HCV-infected persons isto prevent further HCV-transmission using appropriateinterventions to change behaviour leading to HCV transmis-sion (eg needle sharing)However currently most European countries lack specific

policies for HCV screening Only few European countriesperform HCV screening in special subpopulations withelevated HCV prevalence But even in these cases the recom-mendations and medical practices are heterogeneous19ndash21

In March 2007 the European Parliament called for EU-wideaction on Hepatitis C by formally adopting the WrittenDeclaration on Hepatitis C22 Specifically the EuropeanParliament calls for a council recommendation on HepatitisC screening to ensure early diagnosis and wider access totreatment and care within the member states Furthermore theEuropean Liver Patients Association (ELPA) strongly suggeststhat the European Union should encourage tailored screeningcampaigns that target people in at-risk groups23

Despite all potential benefits HCV screening may havesubstantial health-economic consequences and it is not clearwhether it leads to improved long-term health outcomesbecause not all CHC patients will develop progressive liverdisease in their lifetime and not all CHC patients benefitfrom antiviral treatment162425 Furthermore current antiviral

Correspondence Uwe Siebert Department of Public HealthInformation Systems and Health Technology Assessment UMIT ndashUniversity for Health Sciences Medical Informatics and TechnologyEduard Wallnoefer Center I A-6060 Hall iT Austria tel +43-50-8648-3930 fax +43-50-8648-673930 e-mail public-healthumitat

1 Department of Public Health Information Systems and HealthTechnology Assessment UMIT ndash University of Health SciencesMedical Informatics and Technology Hall iT Austria

2 Institute for Technology Assessment and Department of RadiologyMassachusetts General Hospital Harvard Medical School BostonMA USA

3 Department of Internal Medicine Gastroenterology HepatologyPneumology and Endocrinology Johann Wolfgang Goethe-University Frankfurt aM Germany

4 Program in Health Decision Science Department of Health Policyand Management Harvard School of Public Health Boston MAUSA

European Journal of Public Health Vol 19 No 3 245ndash253

The Author 2009 Published by Oxford University Press on behalf of the European Public Health Association All rights reserved

doi101093eurpubckp001 Advance Access published on 5 February 2009

treatment options are costly and impose the burden of sideeffects162425 Therefore a thorough assessment of HCVscreening must consider all consequences for individuals andsociety during a sufficiently long time horizonIn this review we systematically evaluated the current

evidence on long-term effectiveness and cost-effectivenessof screening for Hepatitis C virus infection in differentpopulations

Methods

A systematic literature search was conducted using thedatabases Medline Cochrane Database of SystematicReviews Cochrane central register of controlled trials(CENTRAL) and the NHS databases abstracts of reviews ofeffects (DARE) Health technology assessment (HTA) andEconomic evaluation database (NHS EED) to identify studiesassessing the clinical and economic long-term consequencesof screening for Hepatitis C virus infection (HCV) The timehorizon of the literature search was limited to March 2007 Allreferences were imported into a literature database usinga literature management software program (EndNote 90Thomson ResearchSoft TM Thomson Corporation StamfordCT USA)First reference titles and abstracts were screened for

relevant articles In a second step studies were selected basedon a priori inclusion and exclusion criteria after reading thefull text document We included health technology assessment(HTA) reports systematic reviews long-term clinical trialsfull health economic studies and decision-analytic modellingstudies assessing the impact of screening for Hepatitis C virusinfections As clinical and economic consequences of screeningoccur over a long time horizon we only included studies thatreported both long-term effectiveness and cost effectiveness interms of life-years gained (LYG) quality-adjusted life-yearsgained (QALY) lifetime cost per life-year gained (CostLYG)or cost per quality-adjusted life-year gained (CostQALY)We excluded studies in languages other than English orGerman editorials letters abstracts unsystematic reviewsstudies reporting only short-term effectiveness data (egsustained virological response SVR) studies assessing screen-ing of blood donations or serological testing during antiviraltreatment We also excluded studies that did not reportsufficient data to derive incremental effectiveness and cost-effectiveness ratios or cost-effectiveness studies reporting onlycosts per HCV case detectedWe systematically extracted the results from the publications

and summarized the information in evidence tables reportingclinical and economic outcomesIf necessary and possible we recalculated the incremental

cost-effectiveness ratios (ICER) or incremental cost-utilityratios (ICUR) from the data reported in the publicationTo facilitate comparison across countries and to enable othercountries to transfer our results into their currencies all costswere converted to 2005 Euro (E) using gross domestic productpurchasing power parities (GDPPP) (conversion to Euro ofthe index year) and the German Consumer Price Index(CPI) (inflation to the year 2005)2627 Germany was used asthe reference country for the cost conversion because it is thecountry with the largest population in Europe28

Results

Literature search

A total of 127 unique references were retrieved Tenpublications2029ndash37 including two HTA reports 2036 assessing

lifetime health effects and costs of screening for Hepatitis Cmet the inclusion criteria No long-term clinical trial assessingthe long-term effectiveness (eg mortality) of screening forHepatitis C virus infection and early HCV-treatment wasidentifiedTwo publications by Stein et al3334 reported the cost-

effectiveness results of a decision-analytic model performedwithin an HTA report conducted by the National Institute forHealth and Clinical Excellence (NICE)20 Thompson Coonet al37 reported the cost-effectiveness results of a decision-analytic model performed within an HTA report conductedby the NHS RampD HTA Program36 Only the original data fromthe HTA reports were considered leaving seven studiesin the review


In the absence of clinical trials meta-analyses and healthtechnology assessment reports evaluating the long-termeffectiveness of HCV screening we based our results ondecision-analytic modelling studies that included an analysis oflong-term effectiveness of screening for Hepatitis C virusinfection and early HCV-treatment in terms of undiscountedlife years andor quality-adjusted life years gained comparedto no screening and standard careFive out of seven cost-effectiveness studies reported undis-

counted life years andor quality-adjusted life years gained forscreening and early HCV-treatment compared to no screeningand standard care (table 1)2029303536

The values for life years gained due to screening andearly treatment varied from 00004 LYG (015 life days) forscreening blood recipients to 0066 LYG (241 life days) forscreening all patients assessed for HBV vaccination attendingdrug and alcohol services QALYs varied from no gain forscreening in pregnant women to 0072 QALYs (ie 26 quality-adjusted life days) for screening in patients assessed for HBVvaccination attending drug and alcohol services Screening inpopulations with elevated HCV prevalence (eg IDU) wasmore effective in terms of life-years or QALYs gained Studiesreported 0036ndash0066 LYG (131ndash241 life days) for populationswith 42ndash68 HCV prevalence (0010ndash0072 QALYs37ndash263quality-adjusted life days 32ndash68 HCV prevalence) vs00004ndash0013 LYG (01ndash47 life days) for populations with3ndash16 HCV prevalence (0ndash0022 QALYs0ndash80 quality-adjusted life days 1ndash16 HCV prevalence)

Long-term cost-effectiveness

Health technology assessment reports

Two HTA reports were included One summarizedresults from economic studies evaluating HCV-screeningprogrammes and both HTA reports conducted a cost-effectiveness analysisStein et al 20 systematically reviewed the evidence from

health economic studies evaluating HCV-screening pro-grammes All reviewed studies had methodological limitationsand the results were of limited transferability to the UKcontext Based on their decision-analytic results the authorsconcluded that screening for Hepatitis C in intravenous drugusers in contact with medical services may be moderately cost-effective However the authors recommend interpreting theirresults with caution because of substantial uncertainty aroundthe acceptability of screening the adherence to treatment andthe simple nature of the model General screening in genito-urinary medicine (GUM) clinics is less cost-effective andassociated with greater uncertainty than screening IDUs incontact with medical services

246 European Journal of Public Health

Table

1Lo

ng-term

effectiveness

ofscreeningforhepatitisCundisco

untedlife

years

andorQALY

StudyCountry

Population

HCV

prevalence

()

ScreeningTreatm

ent

Incremental

life

years

(LYG)

Incremental

quality-adjusted

life

years

(QALY

)

Castelnuovo

etal36

Form

erIDUsmeanage37ye

ars

49

Systematicscreeningvsnosystematicscreening(spontaneous

0058

0071

(ThompsonCoonetal37)

Generalpracticemeanage37ye

ars

125

presentationto

screeningpossible)HCV-positive

sreceive

0010

0017

NHSRampD

HTA

Programme

UK

Form

erandcu

rrentIDUsin

generalpracticemean

age37ye

ars

49

treatm

entPegIFN+RBV

0036

0071

Allpatients

assessedforHBVva

ccinationattending

drugandalcoholservicesmeanage37ye

ars

68

0066

0072

Prisoners

atreceptionmeanage37ye

ars

(general

counseling)

16

0013

0022

Prisoners


ars

(counseling

withIDU

focu

s)

42

0036

0058

JusotandColin30

France

Bloodrecipientslt40ye

ars

3ScreeningwithEIA3aftertransfusiontreatm

entforHCV-positive

s

withKnodellscore

5IFN

vsnoscreening+nomedicaltherapy

00085

na

Bloodrecipients

40ndash6

5ye

ars

orreceivinglow-volume

transfusionsorhospitalize

din

asurgery

department


entforHCV-positive

s

withKnodellscore

5IFN


00004

na

Bloodrecipients

receivinghigh-volumetransfusions

3ScreeningwithEIA3before

andaftertransfusion(treatm

entsame

asabove

)

00030ndash0

0047a

na

Lealetal29

UK

IDUsin

contact

withdrugservicesmeanagena

60

ScreeningvsnoscreeningHCV-positive

swithmoderate

toseve

re

CHCreceivetreatm

entIFN

na

0015b

Plunkett

etal35

USA

Pregnantwomenmeanage30ye

ars

1Screeningvsnoscreening70

(screened)or20

(unscreened)of

HCV-positive

swithmoderate

CHCreceivetreatm

ent

PegIFN+RBV

na

000011

1Screeningandtreatm

entasabove

plusCaesariandelive

ryna

00001

Stein

etal20

(Stein

etal20033334)

IDUsin

contact

withdrugservicesmeanage32ye

ars

32

Screeningvsnoscreening50

ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

001003b

NHSRampD

HTA

Programme

UK

Genito-urinary

medicineclinic

attendeesmeanage36ye

ars

15


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

000047b

aRangereportedin

theoriginalstudyforthefirstseco

ndandthirdye

ar

bCalculatedwithdata

intheoriginalpublication

na=

notava

ilableIFN=interferonRBV=ribavirinEIA3=enzy

melinkedassaythirdgenerationPCR=polymerase

chain

reaction

Cost-effectiveness of HCV-screening 247

Castelnuovo et al36 performed a decision-analytic cost-effectiveness study to evaluate screening (named lsquocase-findingrsquo)in patients attending general medical practice or special drugand alcohol services and in prisoners at reception with a focuson former IDUs Based on their analyses the authorsconcluded that screening in these target populations is likelyto be cost-effective despite some uncertainty around theacceptance of testing and treatment

Cost-effectiveness studies

Seven cost-effectiveness studies evaluating HCV screeningin different population settings were included in our review(table 2) Three studies were conducted in the UK202936 twoin France3032 and two in the USA3135

Studies varied in terms of target population study pers-pective time horizon discount rate and compared strategiesincluding screening and antiviral treatment modeFive studies2030ndash3235 evaluated populations at average risk

for Hepatitis C (HCV prevalence 1ndash38) Of those one studyevaluated HCV screening in asymptomatic average-risk adultsin the USA31 one study examined screening in the generalFrench population32 and another study analysed screening inpregnant women in the USA35 two studies consideredscreening in blood recipients3032 and one in generalGenito-urinary medicine clinic attendees20

Four studies20293236 evaluated the cost-effectiveness ofscreening in different populations at higher risk for HCV(HCV prevalence 7ndash80) Four studies evaluated HCVscreening in populations with a history of IDU in differentsettings20293236 two studies analysed the cost-effectiveness ofgeneral screening in attendees of special medical services2036

and one study evaluated HCV screening in prisoners atreception36

Most studies compared systematic screening (and antiviraltreatment for detected HCV-positives) to non-systematicscreening allowing for the possibility of spontaneouscase detection with subsequent antiviral treatment20313536

The percentage of HCV positives eligible for treatment variedSome studies compared screening and antiviral treatmentfor detected HCV positives to no screening and notreatment293032 The antiviral treatment regimens(interferoninterferon plus ribavirinpeginterferon plusribavirin) and algorithms (eg treat all HCV-positives oronly those with severe liver histology) varied Only threestudies203536 evaluated screening followed by peginterferonplus ribavirin the current recommended standard antiviraltherapy38ndash40

The incremental cost-effectiveness ratios (ICER) of HCVscreening vs no screening varied over a wide range (18 300ndash1 151 000EQALY if not dominated) depending on targetpopulation study perspective time horizon discount rate andcompared strategies including screening mode and antiviraltreatment strategies In summary HCV screening in popula-tions with an average HCV prevalence and in pregnant womenwas dominated by no screening Screening in blood recipientsyielded an ICER over 140 600ELYG and was considerednot to be cost-effective30 However this study had a timehorizon of 30 years instead of lifetime and used interferonmonotherapy as antiviral treatment option In contrast HCVscreening in populations with a high HCV prevalencesuch as current or former intravenous drug users was con-sidered cost-effective HCV screening in current andorformer intravenous drug users yielded discounted incre-mental cost-effectiveness ratios below 46 700EQALY2036

General HCV screening amongst members of specialmedical practices (140 500EQALY)20 or in prisoners atreception (30 200EQALY)36 were associated with higher

cost-effectiveness ratios compared to more targeted screening(eg screening only IDUs in these settings)Figure 1 shows the incremental ICER and ICUR ratios of

screening for different HCV prevalence and different antiviraltreatment strategies Most studies evaluated the ICERsICURsin populations with HCV prevalence above 10 Only fourstudies reported results for populations with a lower HCVprevalence Many studies evaluated screening followed byantiviral treatment with interferon or interferon plus ribavirinwhich are not current standard treatment options anymorePeginterferon plus ribavirin the recommended standardantiviral treatment yields more LYsQALYs gained and resultsin much lower ICERsICURs Therefore figure 1c and d showsICERsICURs for screening followed by treatment withpeginterferon plus ribavirin only The majority of thesestudies reported ICURs below 40 000EQALY gained (ICER50 000ELYG) in populations with HCV prevalence above10 and higher ICURs (77 000ndash1 150 000EQALY gained) inlow HCV prevalence populations (results from two studies)

Discussion

We performed a systematic review on the long-term effective-ness and cost-effectiveness of screening for HCV infectionDepending on HCV prevalence and risk selection mode

the incremental long-term effectiveness of HCV screening andearly treatment compared to no screening and standard carevaried from 00004 LYG (015 life-days gained) to 0066 LYG(24 life-days gained) and from 00001 QALY (004 quality-adjusted life-days gained) to 0072 QALY (26 quality-adjustedlife-days gained) To put these figures into perspective theycan be compared with other screening programs For examplebiennial cervical cancer screening compared to no screening isassociated with a gain of 92 life days Moving from a 2-year toa 1-year interval is associated with a gain of four life days41

Given 1 undetected HIV-prevalence one-time HIVscreening in US health care settings was reported to increaselife-expectancy by 39 days (29 quality-adjusted life days)Screening every 5 years would gain additional 097 days(070 quality-adjusted life days)42

It must be noted that these numbers reflect the averageincremental life expectancy per person screened This trans-lates to many persons with no gain and some persons withseveral years or decades gain in life expectancyThe incremental cost-effectiveness ratios varied over a wide

range depending on target population (eg HCV prevalenceage etc) study perspective time horizon discount rate andcompared strategies including screening settings and antiviraltreatment strategies Therefore the comparability of theresults is limitedHCV screening vs no screening resulted in ICURs ranging

from 18 300 to 1 151 000EQALY if screening was notdominated In the reviewed studies HCV screening wasconsidered cost-effective (ICURs below 40 000EQALY fortreatment with peginterferon plus ribavirin) in populationswith an elevated HCV prevalence such as intravenous drugusers General HCV screening in average-risk adults wasunlikely to be effective and cost-effectiveHowever cost-effectiveness should not be the main criterion

for the decision to implement HCV screening Given thesubstantial number of prevalent iatrogenic HCV-infected casesother ethical concepts such as fairness and equity may beconsidered as wellCost-effectiveness is depending on the willingness-to-pay in

a certain society which depends on several economical socialand political factors There is currently no general agreementacross countries about the cost-effectiveness threshold To givea measurement on the incremental cost-effectiveness ratios of


Table

2Disco

untedincrementalco

st-effectiveness-ratios(ICER)anddisco

untedincrementalco

st-utility-ratios(ICUR)forscreeningforhepatitisC

StudyCountry

CurrencyYear

Perspective

Disco

unt

rate

()

Comparator

TargetPopulation

ICER

(ELYG)

ICUR

(EQ

ALY

)

Castelnuovo

etal36

(ThompsonCoon

UKpound2004

NationalHealth

6(costs)15

(effects)

Systematicscreeningvsnosystematicscreening

(spontaneouspresentationto

screeningpossible)

Form

erIDUsgeneralcasemeanage37ye

ars49

HCV

preva

lence

30232

24858

etal37)

Services(N

HS)

HCV-positive

sreceivetreatm

entPegIFN+RBV


ars125

HCVpreva

lence

38633

23321

NHSRampD

HTA

Programme

Form

erandcu

rrentIDUsin

generalpracticemeanage

37ye

ars49

HCV

preva

lence

30194

24827

UK

Allpatients

assessedforHBVva

ccinationattendingdrugand

alcoholservicesmeanage37ye

ars68

HCV

preva

lence

28689

26365

(Screeningincludedgenerallecture

onHCV)

Prisoners


ars16

HCVpreva

lence

50833

30231

(Screeningincludedlecture

withfocu

sonIDU

andrisk

ofHCV)

Prisoners


ars42

HCVpreva

lence

40301

24813

JusotandColin30

France

FF1996Health

care

system

30ye

ars

time

Nodisco

unt

rate

ScreeningwithEIA3aftertransfusiontreatm

ent

forHCV-positive

swithKnodellscore

5IFN

vs

noscreening+nomedicaltherapy


ars3

HCV

preva

lence

140674

mdash

horizo

nScreeningwithEIA3aftertransfusiontreatm

ent

forHCV-positive

swithKnodellscore

5IFN

vs


Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department

3

HCV

preva

lence

477654

mdash

ScreeningwithEIA3before

andaftertransfusion

(treatm

entsameasabove

)

Bloodrecipients


3

HCV

preva

lence

144970

mdash

Lealetal29

UKpound1997na

6ScreeningvsnoscreeningHCV-positive

swithmoderate

IDUsin

contact

withdrugservices60

HCV

preva

lence

mdash119754

UK

toseve

reCHCreceivetreatm

entIFN

(IFN

+RBV)

(18267-34537a)

Loubiere

etal32

France

E1998Health

care

system

3ScreeningwithEIA3+EIA3vsnoscreening+notreatm

ent

50

ofCHCcasesand40

ofcirrhosiscasesreceive

treatm

entIFN+RBV

IDUs80

HCV

preva

lence

3881

mdash

ScreeningwithEIA3+PCRvsnoscreening+notreatm

ent

treatm

entasabove

9742

mdash

ScreeningwithEIA3+EIA3vsnoscreening+treatm

entif

cirrhosistreatm

entasabove

Patients

transfusedbefore

19917

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash

ScreeningwithEIA3+PCRvsnoscreening+treatm

entif

cirrhosistreatm

entasabove

243737

mdash


entif

cirrhosistreatm

entasabove

GeneralFrench

population12

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

5005

mdash

Plunkett

etal35

USA

US$

2003Health

care

system


sreceivetreatm

ent

PegIFN+RBV

Pregnantwomen1

HCV

preva

lence

mdashNoscreening

dominant

Asabove

plusCaesariandelive

rymdash

1150976

Singeretal31

USA

US$

2001S

ocietal


ofHCV-positive

sreceive

treatm

entIFN+RBV

Asymptomatic

ave

ragerisk

adultsmeanage35ye

ars

38

HCV

preva

lence

mdashNoscreening

dominant

Stein

etal20

(Stein

etal3334)

UKpound2001

NationalHealth

6(costs)15

(effects)


ofHCV-positive

swith

moderate

CHCreceivetreatm

entIFN+RBV(PegIFN+RBV)

IDUsin

contact


ars

32

HCV

preva

lence

mdash46707(23598)

NHSRampD

HTA

Programme

Services(N

HS)

Allscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm


Genito-urinary

medicineclinic

attendeesmeanage

36ye

ars15

HCVpreva

lence

mdash140471(77052)

UK

IDUsscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm

entIFN+RBV

32

HCVpreva

lence

mdash45076

aDependingontreatm

entduration(24or48weeks)

andribavirindosage(1000or1200mgd)

na=

notava



chain

reaction


well-accepted screening programs cytological screening forcervical cancer every 3 years compared to no screening costspound1800 per life year gained in the UK43 1400ELYG inGermany44 and 8400 US$LYG in the USA45 Screening blooddonors for HIV costs 14 000 US$LYG46 Given 1 undetectedHIV-prevalence one-time HIV screening in US health caresettings would result in 41 700 US$QALY screening every 5years 123 600 US$QALY42

In the absence of long-term clinical trials all results wereretrieved from decision-analytic studies which link diagnosticand clinical short-term outcomes (eg test sensitivity andspecificity or viral response) to clinical long-term outcomes(eg mortality and long-term quality of life)47 The includedstudies were heterogeneous in regard to health economicanalysis techniques (eg time horizons discounting etc)HCV population prevalence acquisition risk factors andantiviral therapy Therefore the outcomes in terms of lifeyears gained quality adjusted life years and incremental costeffectiveness ratios varied over a wide range However severalresults were logical and predictable for example screening ismore cost effective in higher prevalence or higher riskpopulationsmdasha result that has been reported for other diseasestoo4849

Like all decision-analytic models screening models mustsimplify the real world for more transparency and thepossibility to analyse specific research questions47 However

some methodological and structural model assumptions mayhave an important impact on clinical and economic outcomesand could lead to bias in favour for or against HCV screeningThus it is important to discuss some aspects essential fora valuable screening modelFirst it is important to allow for the possibility of

spontaneous case detection by symptoms with subsequentantiviral treatment in the non-screening strategy of any HCV-screening model Without these estimates the benefits of thescreening strategy are overestimated and outcomes are biasedin favour of the HCV-screening strategy Second the settingof antiviral treatment in both strategies is very important Notreatment in the non-screening strategy or lsquowait and treatcirrhosisrsquo vs lsquoscreen and treat all HCV-positive patientsrsquomay overestimate both the incremental benefits and costs ofscreening Therefore antiviral treatment should be consideredfor chronic HCV-patients (detected through screeningsymptoms or spontaneous presentation) in both strategiesaccording to recent treatment guidelines Third moststudies considered antiviral therapy with interferon plusribavirin20293132 and two studies used even interferonmonotherapy293032 Only three studies considered peginter-feron plus ribavirin203536 Having better treatment optionsand administering antiviral treatment according to genotype-specific guidelines with early treatment stop for patients notresponding would allow tailoring treatment efficiently which

Figure 1 Incremental cost-effectiveness ratio of screening compared to no screening in Euro per life year gained (EuroLYG) orquality-adjusted life-year gained (EuroQALY) for different HCV prevalence in the target population (a) ICER (in EuroLYG) ofHCV screening and different antiviral treatment (b) ICUR (in EuroQALY) of HCV screening and different antiviral treatment (c)ICER (in EuroLYG) of HCV screening and antiviral treatment with peginterferon plus ribavirin (d) ICUR (in EuroQALY) of HCVscreening and antiviral treatment with peginterferon plus ribavirin (Each point represents the ICERICUR of a specific targetpopulation and screeningtreatment strategy Multiple points may come from the same modelling study) IFN= interferonRBV= ribavirin PegIFN=peginterferon One point out of range of figure 1(d) 1 150 976QALY with 1 HCV prevalencePegIFN+RBV


would reduce adverse effects harms and antiviral treatmentcosts and improve the cost-effectiveness of HCV screening dueto better clinical and economic outcomes Fourth eligibilityof patients for and adherence to antiviral treatment shouldbe considered In particular any HCV-screening modelshould consider a lsquowait and seersquo strategy in the screeningarm because not all patients necessarily should or want to betreated immediately after HCV detection50 HCV screeningand watchful monitoring HCV-infected patients may be moreeffective and cost-effective than screening with immediatetreatment of all HCV-infected patients since a fraction ofHCV-infected patients may not develop fibrosis or cirrhosisduring their lifetime This is particularly important for theelderlyThe age at which HCV-infected patients are identified and

treated is a very important modelling factor as well Moststudies used an average age of 40 years for the evaluatedpopulation which may be adequate for patients with CHCwhich already developed symptoms However HCV screeningmay detect HCV-infected individuals earlier at significantlyyounger age In addition certain HCV-infected populationsat risk for advanced liver disease such as intravenous druguser or ethnic minority groups who have acquired HCViatrogenically in early childhood have a significantly youngeraverage age Thus in these cases benefits from early detectionand treatment may be underestimatedDiscounting costs and effects is important and affects ICERs

since the clinical and economic benefits of screening due toavoided cirrhosis and its sequelae occur in the distant futurewhereas the costs of screening and antiviral treatment occurmuch earlier One study30 in France did not discount at all andtwo studies 2036 conducted in the UK used different discountrates for costs and effects The ICERs increased significantly insensitivity analyses when cost and effects were equallydiscounted with 35 annually (eg from 16 514 poundQALY to33 235 poundQALY36)Most studies used a lifelong time horizon for their analyses

which is the most adequate timeframe to use As benefits thatoccur far in the future will not be considered within shortertime horizons estimated cost-effectiveness ratios may be toohigh One study used a 30 year time horizon30 As cirrhosisand its complications develop slowly within 10ndash30 years eventhis time horizon may be too short and benefits may beunderestimatedAll studies included in this review take into account the

natural history of chronic Hepatitis C disease progression andmortality from CHC-related complications Only one studyused the natural history of chronic Hepatitis B diseaseprogression as at that time no information existed regardingHepatitis C progression However it was not always clearwhether slower progression rates were considered for screenedpopulations tending to present histological milder Hepatitis Ccompared to non-screened populations mostly detected bysymptoms Several studies reported that patients with mildCHC and normal ALT levels may have a reduced risk ofprogression to cirrhosis compared to patients with more severehistology or elevated ALT levels751ndash54 Furthermore analysesfor CHC patients co-infected with HIV should assume higherprogression rates to CHC-related liver diseases than analysesin non-co-infected CHC patients5556In addition most studies used age- and gender-specific

mortality rates of the general population for the backgroundmortality for CHC patients However background mortality isoften higher due to co-morbidity from other diseases such asHIV- or HBV-coinfection or in case of IDUs from continua-tion of or relapse to drug abuse Even patients with moderateCHC or cirrhosis that respond to antiviral treatment continue

to have an increased risk of developing hepatocellularcarcinoma which is associated with significant mortalityOverall this review discovered many study limitations and

the need for further systematic research in HCV screeningParticularly health-economic studies in population with lowor average HCV prevalence evaluating HCV screeningcombined with different strategies of monitoring and antiviraltreatment of HCV-positives according to current treatmentstandard are requiredFinally it must be mentioned that due to different

epidemiology health care systems disease managementpractice patterns and treatment costs in different Europeancountries results cannot be generalized and are difficult if notimpossible to be directly transferred from one country toanother Further research should focus on the development ofa Pan-European Hepatitis C screening model that fulfils thequality criteria discussed above and which can be adapted tothe context of the different health care systems and countrieswithin Europe

Conclusion

Although HCV screening fulfils general population screeningcriteria specific well-formulated national programs forHepatitis C screening are lacking in most European countriesBased on current evidence HCV screening and early treatmenthas the potential to improve average life-expectancy butshould focus on populations with elevated HCV prevalence tobe cost-effective Further research is needed to investigate thelong-term health-economic impact of HCV screening whencombined with appropriate monitoring and treatmentstrategies in different European health care systems Furtherassessments should focus on determining optimal targetgroups and settings that yield effective and cost-effectiveHCV screening strategies

Acknowledgements

We thank the members of the PanEuropean Hepatitis C ExpertPanel for providing local information and reviewing the resultsof our study Maria Buti MD Hospital General UniversitarioVall de Hebron Barcelona Spain Florin Caruntu Matei BalsInfectious Disease Institute Bucharest and Carol DavilaMedicine and Pharmacy University Bucharest RomaniaCharles Gore The Hepatitis C Trust London UK Scott DHolmberg MD MPH Epidemiology and Surveillance BranchDivision of Viral Hepatitis Prevention NCHHSTP Centers forDisease Control and Prevention Atlanta GA USA NadinePiorkowsky The European Liver Patients Association (ELPA)Germany Prof William Rosenberg Institute of HepatologyUniversity College London UK However the authors aloneare responsible for the results reported and views expressed inthe paper The authors had complete and independent controlover study design analysis and interpretation of data reportwriting and publication regardless of results

Funding

This project was supported in part by an unrestrictededucational grant from Hoffmann La-Roche Ltd BaselSwitzerland

Conflicts of interest NM has received travel support fromHoffmann La-Roche Ltd to present preliminary results of thestudy to different audiences US has received healthtechnology assessment research grants from the GermanFederal Ministry of Health and the Austrian Academy of


Sciences and unrestricted research grants from ScheringPlough and Roche

Key points

Although HCV screening fulfils general populationscreening criteria specific well-formulated nationalpublic health programs for hepatitis C screening arelacking in most European countries

According to this review HCV screening with earlytreatment has the potential to improve averagelife-expectancy but should focus on populationswith elevated HCV prevalence to be cost-effectiveAppropriate target groups could be selected based onrisk factor profiles

Appropriate monitoring and treatment strategiesfor detected early disease may improve the cost-effectiveness of HCV screening

In view of the multitude of iatrogenic infectionshowever cost-effectiveness may not be the onlydecision criterion for the implementation of HCVscreening Aspects like fairness might be considered aswell

Further research should focus on the public-healthimpact of HCV screening when combined withappropriate monitoring and treatment strategies andon determining optimal target groups and settings

References

1 Weissing L Roy K Sapinho D et al Surveillance of hepatitis C infection

among injecting drug users in the European Union In Jager J Limburg W

Kretzschmar M et al editors Hepatitis C and injecting drug use

Luxembourg European Monitoring Centre for Drugs and Drug Addiction

2006 91ndash135

2 European Centre for Disease Prevention and Control (ECDC) Annual

epidemiologic report on communicable diseases in Europe 2007 http

wwwecdceuropaeu (date last accessed 28 June 2007)

3 Rantala M van de Laar MJ Surveillance and epidemiology of hepatitis B and

C in Europe ndash a review Euro Surveill 200813 Available online

httpwwweurosurveillanceorg (date last accessed 13 December 2008)

4 Alter H Seeff L Recovery persistence and sequelae in hepatitis C virus

infection a perspective on long-term outcome Semin Liver Dis

20002017ndash35

5 Anonymous EASL international consensus conference on hepatitis C

Paris 26ndash27 February 1999 Consensus statement J Hepatol

199931(Suppl 1)3ndash8

6 Dore GJ Freeman AJ Law M Kaldor JM Is severe liver disease a common

outcome for people with chronic hepatitis C J Gastroenterol Hepatol

200217423ndash30

7 Freeman A Dore G Law M et al Estimating progression to cirrhosis in

chronic hepatitis C virus infection Hepatology 200134809ndash16

8 Freeman AJ Law MG Kaldor JM Dore GJ Predicting progression

to cirrhosis in chronic hepatitis C virus infection J Viral Hepat

200310285ndash93

9 Hopf U Moller B Kuther D et al Long-term follow-up of posttransfusion

and sporadic chronic hepatitis non-A non-B and frequency of circulating

antibodies to hepatitis C virus (HCV) J Hepatol 19901069ndash76

10 Koretz R Abbey H Coleman E Gitnick G Non-A non-B post-transfusion

hepatitis Looking back in the second decade Ann Intern Med

1993119110ndash5

11 Mattsson L Outcome of acute symptomatic non-A non-B hepatitis

a 13-year follow-up study of hepatitis C virus markers Liver

199313274ndash8

12 Tremolada F Casarin C Alberti A et al Long-term follow-up of non-A

non-B (type C) post-transfusion hepatitis J Hepatol 199216273ndash81

13 World Health Organization (WHO) Global surveillance and control of

hepatitis C Report of a WHO consultation organized in collaboration with

the Viral Hepatitis Prevention Board Antwerp Belgium J Viral Hepatitis

1999635ndash47

14 Wilson J Jungner Y Principles and practice of mass screening for disease

Bol Oficina Sanit Panam 196865281ndash393

15 Wilson J The evaluation of the worth of early disease detection J R Coll Gen

Pract 196816(Suppl 2)48ndash57

16 Brady B Siebert U Sroczynski G et al Pegylated interferon combined with

ribavirin for chronic hepatitis C virus infection an economic evaluation

[Technology Report No 82] Ottawa Canadian Agency for Drugs and

Technologies in Health 2007

17 Wright M Grieve R Roberts J Main J Thomas HC on behalf of the UK

Mild Hepatitis C Trial Investigators Health benefits of antiviral therapy for

mild chronic hepatitis C randomised controlled trial and economic

evaluation Health Technol Assess 2006101ndash132

18 Maheshwari A Ray S Thuluvath PJ Acute hepatitis C Lancet

2008372321ndash32

19 Jullien-Depradeux AM Bloch J Le Quellec-Nathan M Abenhaim A

National campaign against hepatitis C in France (1999ndash2002) Acta

Gastroenterol Belg 200265112ndash4

20 Stein K Dalziel K Walker A et al Screening for hepatitis C among injecting

drug users and in genitourinary medicine clinics systematic reviews of

effectiveness modelling study and national survey of current practice

Health Technol Assess 200261ndash122

21 Department of HealthGeneral Health Protection Hepatitis C Action Plan

for England July 2004 Available at wwwdhgovukpublications (date last

accessed 12 November 2006

22 European Liver Patient Association (ELPA) European Parliament demands

EU-wide action on Hepatitis C 2007 httpwwwelpaorg (date last accessed

15 May 2007)

23 European Liver Patient Association (ELPA) Promoting Hepatitis C Screening

in Europe 2007 httpwwwelpaorg (date last accessed 8 May 2008)

24 Shepherd J Brodin HFT Cave CB et al Clinical- and cost-effectiveness of

pegylated interferon alfa in the treatment of chronic hepatitis C a systematic

review and economic evaluation Int J Technol Assess Health Care

20052147ndash54

25 Siebert U Sroczynski G on behalf of the German Hepatitis C Model

(GEHMO) Group and the HTA Expert Panel on Hepatitis C Antiviral

therapy for patients with chronic hepatitis C in Germany Evaluation of

effectiveness and cost-effectiveness of initial combination therapy with

InterferonPeginterferon plus Ribavirin Series of the German Institute for

Medical Documentation and Information commissioned by the Federal

Ministry of Health and Social Security Cologne DIMDI 2003

26 Organisation for Economic Co-operation and Development (OECD) Gross

domestic product purchasing power parities 2006 httpwwwoecdorg

27 German Federal Statistical Office German Consumer Price Index (CPI) 2006

httpwwwdestatisde

28 Population Division of the Department of Economic and Social Affairs of the

United Nations Secretariat World population prospects the 2006 revision and

world urbanization prospects the 2005 revision httpesaunorgunpp

29 Leal P Stein K Rosenberg W What is the cost utility of screening for

hepatitis C virus (HCV) in intravenous drug users J Med Screen

19996124ndash31

30 Jusot JF Colin C Cost-effectiveness analysis of strategies for hepatitis C

screening in French blood recipients Eur J Public Health 200111373ndash9

31 Singer ME Younossi ZM Cost effectiveness of screening for hepatitis C virus

in asymptomatic average-risk adults Am J Med 2001111614ndash21

32 Loubiere S Rotily M Moatti JP Prevention could be less cost-effective than

cure the case of hepatitis C screening policies in France Int J Technol Assess

Health Care 200319632ndash45

33 Stein K Dalziel K Walker A et al Screening for hepatitis C in genito-urinary

medicine clinics a cost utility analysis J Hepatol 200339814ndash25

34 Stein K Dalziel K Walker A et al Screening for Hepatitis C in injecting drug

users a cost utility analysis J Public Health 20042661ndash71


35 Plunkett BA Grobman WA Routine hepatitis C virus screening in

pregnancy a cost-effectiveness analysis Am J Obstet Gynecol

20051921153ndash61

36 Castelnuovo E Thompson-Coon J Pitt M et al The cost-effectiveness of

testing for hepatitis C in former injecting drug users Health Technol Assess

200610 iiindashiv ixndashxii 1ndash93

37 Thompson Coon J Castelnuovo E Pitt M et al Case finding for hepatitis C

in primary care a cost utility analysis Fam Pract 200623393ndash406

38 Sherman M Shafran S Burak K et al Management of chronic hepatitis C

consensus guidelines Can J Gastroenterol 200721(Suppl C)25Cndash34C

39 NIH Consensus Statement National institutes of health consensus devel-

opment conference management of Hepatitis C 2002 - June 10ndash12 2002

Hepatology 200236(5 Suppl 1)S3ndash20

40 Zeuzem S Standard treatment of acute and chronic hepatitis C

Z Gastroenterol 200442714ndash9

41 Siebert U Sroczynski G Hillemanns P et al The German cervical cancer

screening model development and validation of a decision-analytic model

for cervical cancer screening in Germany Eur J Public Health

200616185ndash92

42 Sanders G Bayoumi A Sundaram V et al Cost-effectiveness of screening for

HIV in the era of highly active antiretroviral therapy N Engl J Med

2005352570ndash85

43 Payne N Chilcott J McGoogan E Liquid-based cytology in cervical

screening a rapid and systematic review Health Technol Assess 200041ndash73

44 Siebert U Muth C Sroczynski G et al Liquid-based preparation and

computer-assisted examination of cervical smears in cervical cancer screening

Clinical effectiveness economic evaluation and systematic decision analysis

Series of the German Institute for Medical Documentation and Information

commissioned by the Federal Ministry of Health and Social Security St

Augustin Asgard 2004

45 McCrory DC Matchar DB Evaluation of cervical cytology - systematic

review HTA Report Agency for Health Care Research and Quality (AHRQ)

Report No 5 1999

46 Tengs T Adams M Pliskin J et al Five-hundred life-saving interventions

and their cost-effectiveness Risk Anal 199515369ndash90

47 Siebert U When should decision-analytic modeling be used in the

economic evaluation of health care [Editorial] Eur J Health Econ

20034143ndash50

48 Shamir R Hernell O Leshno M Cost-effectiveness analysis of

screening for celiac disease in adult population Med Decis Making

200626282ndash93

49 Hayashino Y Shimbo T Tsujii S et al Cost-effectiveness of coronary artery

disease screening in asymptomatic patients with type 2 diabetes and other

atherogenic risk factors in Japan factors influencing on international

application of evidence-based guidelines Int J Cardiol 200711888ndash96

50 Wong JB Koff RS Watchful waiting with periodic liver biopsy versus

immediate empirical therapy for histologically mild chronic hepatitis C A

cost-effectiveness analysis Ann Intern Med 2000133665ndash75

51 Alberti A Morsica G Chemello L et al Hepatitis C viremia and liver

disease in symptom-free individuals with anti-HCV Lancet

1992340697ndash8

52 Alter H Conry-Cantilena C Melpolder J et al Hepatitis C in asymptomatic

blood donors Hepatology 199726(3 Suppl 1)29Sndash33S

53 Marcellin P Levy S Erlinger S Therapy of hepatitis C patients with normal

aminotransferase levels Hepatology 199726(3 Suppl 1)133Sndash6S

54 Mathurin P Moussalli J Cadranel J et al Slow progression rate of fibrosis in

hepatitis C virus patients with persistently normal alanine transaminase

activity Hepatology 199827868ndash72

55 Graham CS Baden LR Yu E et al Influence of human immunodeficiency

virus infection on the course of hepatitis C virus infection a meta-analysis

Clin Infect Dis 200133562ndash9

56 Soto B Sanchez-Quijano A Rodrigo L et al Human immunodeficiency

virus infection modifies the natural history of chronic parenterally-acquired

hepatitis C with an unusually rapid progression to cirrhosis J Hepatol

1997261ndash5

Received 14 September 2008 accepted 22 December 2008


Are the best practicesmethodologyresults described applicable in developed countries

Similar cost-effectiveness systematic review can be done However results cannot be generalized to various countries because of treatment costs differences and HCV management screening and treatment

YES NO NA COMMENTS

Are the best practicesmethodologyresults described applicable in developing countries

Studies included in this review originate only from European countries and USA

The research studytooldata dictionary is easily accessedavailable electronically

Purchase required for access at httponlinelibrarywileycom

Is there evidence of cost effective analysis with regard to interventions diagnosis treatment or surveillance methodologies If so what does the evidence say Please go to Comments section

Seven cost-effectiveness studies included in this review

- Incremental cost-effectiveness ratios (ICER) varied depending on the target population study perspective time horizon discount rate and compared strategies

- ICER of HCV screening vs no screening varied from 18300 to 1151000 euroQALY

- Screening in blood recipients not cost-effective given ICER over 140600 euroQALY

- HCV screening was considered cost-effective (ICURs below 40000 euroQALY for treatment with peg-IFN plus RBV) in populations with an elevated HCV prevalence such as intravenous drug users

Are there increased costs (infrastructure manpower skillstraining analysis of data) to using the research studytooldata dictionary

How is the research studytool funded Please got to Comments section

This study was supported in part by Hoffmann La-Roche Ltd Basel Switzerland












RESEARCH REPORTS









Introduction



















Methods





Results

Literature search













Table

1Lo

ng-term

effectiveness


untedlife

years

andorQALY

StudyCountry

Population

HCV

prevalence

()

ScreeningTreatm

ent

Incremental

life

years

(LYG)

Incremental

quality-adjusted

life

years

(QALY

)

Castelnuovo

etal36

Form

erIDUsmeanage37ye

ars

49


0058

0071



ars

125

presentationto


sreceive

0010

0017

NHSRampD

HTA

Programme

UK

Form

erandcu

rrentIDUsin

generalpracticemean

age37ye

ars

49

treatm

entPegIFN+RBV

0036

0071

Allpatients

assessedforHBVva

ccinationattending


ars

68

0066

0072

Prisoners


ars

(general

counseling)

16

0013

0022

Prisoners


ars

(counseling

withIDU

focu

s)

42

0036

0058

JusotandColin30

France


ars


entforHCV-positive

s

withKnodellscore

5IFN


00085

na

Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department


entforHCV-positive

s

withKnodellscore

5IFN


00004

na

Bloodrecipients




entsame

asabove

)

00030ndash0

0047a

na

Lealetal29

UK

IDUsin

contact


60


swithmoderate

toseve

re

CHCreceivetreatm

entIFN

na

0015b

Plunkett

etal35

USA


ars


(screened)or20

(unscreened)of

HCV-positive

swithmoderate

CHCreceivetreatm

ent

PegIFN+RBV

na

000011

1Screeningandtreatm

entasabove

plusCaesariandelive

ryna

00001

Stein

etal20

(Stein

etal20033334)

IDUsin

contact


ars

32


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

001003b

NHSRampD

HTA

Programme

UK

Genito-urinary

medicineclinic


ars

15


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

000047b

aRangereportedin


ndandthirdye

ar

bCalculatedwithdata


na=

notava



chain

reaction















Discussion










Table

2Disco

untedincrementalco


untedincrementalco


StudyCountry

CurrencyYear

Perspective

Disco

unt

rate

()

Comparator

TargetPopulation

ICER

(ELYG)

ICUR

(EQ

ALY

)

Castelnuovo

etal36

(ThompsonCoon

UKpound2004

NationalHealth

6(costs)15

(effects)



screeningpossible)

Form


ars49

HCV

preva

lence

30232

24858

etal37)

Services(N

HS)

HCV-positive

sreceivetreatm

entPegIFN+RBV


ars125

HCVpreva

lence

38633

23321

NHSRampD

HTA

Programme

Form

erandcu

rrentIDUsin


37ye

ars49

HCV

preva

lence

30194

24827

UK

Allpatients

assessedforHBVva



ars68

HCV

preva

lence

28689

26365


onHCV)

Prisoners


ars16

HCVpreva

lence

50833

30231


withfocu

sonIDU

andrisk

ofHCV)

Prisoners


ars42

HCVpreva

lence

40301

24813

JusotandColin30

France

FF1996Health

care

system

30ye

ars

time

Nodisco

unt

rate


ent

forHCV-positive

swithKnodellscore

5IFN

vs



ars3

HCV

preva

lence

140674

mdash

horizo


ent

forHCV-positive

swithKnodellscore

5IFN

vs


Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department

3

HCV

preva

lence

477654

mdash


andaftertransfusion

(treatm

entsameasabove

)

Bloodrecipients


3

HCV

preva

lence

144970

mdash

Lealetal29

UKpound1997na


swithmoderate

IDUsin

contact

withdrugservices60

HCV

preva

lence

mdash119754

UK

toseve

reCHCreceivetreatm

entIFN

(IFN

+RBV)

(18267-34537a)

Loubiere

etal32

France

E1998Health

care

system


ent

50

ofCHCcasesand40


treatm

entIFN+RBV

IDUs80

HCV

preva

lence

3881

mdash


ent

treatm

entasabove

9742

mdash


entif

cirrhosistreatm

entasabove

Patients

transfusedbefore

19917

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

243737

mdash


entif

cirrhosistreatm

entasabove

GeneralFrench

population12

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

5005

mdash

Plunkett

etal35

USA

US$

2003Health

care

system


sreceivetreatm

ent

PegIFN+RBV

Pregnantwomen1

HCV

preva

lence

mdashNoscreening

dominant

Asabove

plusCaesariandelive

rymdash

1150976

Singeretal31

USA

US$

2001S

ocietal


ofHCV-positive

sreceive

treatm

entIFN+RBV

Asymptomatic

ave

ragerisk

adultsmeanage35ye

ars

38

HCV

preva

lence

mdashNoscreening

dominant

Stein

etal20

(Stein

etal3334)

UKpound2001

NationalHealth

6(costs)15

(effects)


ofHCV-positive

swith

moderate

CHCreceivetreatm


IDUsin

contact


ars

32

HCV

preva

lence

mdash46707(23598)

NHSRampD

HTA

Programme

Services(N

HS)

Allscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm


Genito-urinary

medicineclinic

attendeesmeanage

36ye

ars15

HCVpreva

lence

mdash140471(77052)

UK

IDUsscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm

entIFN+RBV

32

HCVpreva

lence

mdash45076

aDependingontreatm



na=

notava



chain

reaction


















Conclusion


Acknowledgements


Funding





Key points






References





2006 91ndash135









20002017ndash35






200217423ndash30





200310285ndash93






1993119110ndash5



199313274ndash8






1999635ndash47














2008372321ndash32













15 May 2007)






20052147ndash54











httpwwwdestatisde






19996124ndash31















20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5














RESEARCH REPORTS









Introduction



















Methods





Results

Literature search













Table

1Lo

ng-term

effectiveness


untedlife

years

andorQALY

StudyCountry

Population

HCV

prevalence

()

ScreeningTreatm

ent

Incremental

life

years

(LYG)

Incremental

quality-adjusted

life

years

(QALY

)

Castelnuovo

etal36

Form

erIDUsmeanage37ye

ars

49


0058

0071



ars

125

presentationto


sreceive

0010

0017

NHSRampD

HTA

Programme

UK

Form

erandcu

rrentIDUsin

generalpracticemean

age37ye

ars

49

treatm

entPegIFN+RBV

0036

0071

Allpatients

assessedforHBVva

ccinationattending


ars

68

0066

0072

Prisoners


ars

(general

counseling)

16

0013

0022

Prisoners


ars

(counseling

withIDU

focu

s)

42

0036

0058

JusotandColin30

France


ars


entforHCV-positive

s

withKnodellscore

5IFN


00085

na

Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department


entforHCV-positive

s

withKnodellscore

5IFN


00004

na

Bloodrecipients




entsame

asabove

)

00030ndash0

0047a

na

Lealetal29

UK

IDUsin

contact


60


swithmoderate

toseve

re

CHCreceivetreatm

entIFN

na

0015b

Plunkett

etal35

USA


ars


(screened)or20

(unscreened)of

HCV-positive

swithmoderate

CHCreceivetreatm

ent

PegIFN+RBV

na

000011

1Screeningandtreatm

entasabove

plusCaesariandelive

ryna

00001

Stein

etal20

(Stein

etal20033334)

IDUsin

contact


ars

32


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

001003b

NHSRampD

HTA

Programme

UK

Genito-urinary

medicineclinic


ars

15


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

000047b

aRangereportedin


ndandthirdye

ar

bCalculatedwithdata


na=

notava



chain

reaction















Discussion










Table

2Disco

untedincrementalco


untedincrementalco


StudyCountry

CurrencyYear

Perspective

Disco

unt

rate

()

Comparator

TargetPopulation

ICER

(ELYG)

ICUR

(EQ

ALY

)

Castelnuovo

etal36

(ThompsonCoon

UKpound2004

NationalHealth

6(costs)15

(effects)



screeningpossible)

Form


ars49

HCV

preva

lence

30232

24858

etal37)

Services(N

HS)

HCV-positive

sreceivetreatm

entPegIFN+RBV


ars125

HCVpreva

lence

38633

23321

NHSRampD

HTA

Programme

Form

erandcu

rrentIDUsin


37ye

ars49

HCV

preva

lence

30194

24827

UK

Allpatients

assessedforHBVva



ars68

HCV

preva

lence

28689

26365


onHCV)

Prisoners


ars16

HCVpreva

lence

50833

30231


withfocu

sonIDU

andrisk

ofHCV)

Prisoners


ars42

HCVpreva

lence

40301

24813

JusotandColin30

France

FF1996Health

care

system

30ye

ars

time

Nodisco

unt

rate


ent

forHCV-positive

swithKnodellscore

5IFN

vs



ars3

HCV

preva

lence

140674

mdash

horizo


ent

forHCV-positive

swithKnodellscore

5IFN

vs


Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department

3

HCV

preva

lence

477654

mdash


andaftertransfusion

(treatm

entsameasabove

)

Bloodrecipients


3

HCV

preva

lence

144970

mdash

Lealetal29

UKpound1997na


swithmoderate

IDUsin

contact

withdrugservices60

HCV

preva

lence

mdash119754

UK

toseve

reCHCreceivetreatm

entIFN

(IFN

+RBV)

(18267-34537a)

Loubiere

etal32

France

E1998Health

care

system


ent

50

ofCHCcasesand40


treatm

entIFN+RBV

IDUs80

HCV

preva

lence

3881

mdash


ent

treatm

entasabove

9742

mdash


entif

cirrhosistreatm

entasabove

Patients

transfusedbefore

19917

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

243737

mdash


entif

cirrhosistreatm

entasabove

GeneralFrench

population12

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

5005

mdash

Plunkett

etal35

USA

US$

2003Health

care

system


sreceivetreatm

ent

PegIFN+RBV

Pregnantwomen1

HCV

preva

lence

mdashNoscreening

dominant

Asabove

plusCaesariandelive

rymdash

1150976

Singeretal31

USA

US$

2001S

ocietal


ofHCV-positive

sreceive

treatm

entIFN+RBV

Asymptomatic

ave

ragerisk

adultsmeanage35ye

ars

38

HCV

preva

lence

mdashNoscreening

dominant

Stein

etal20

(Stein

etal3334)

UKpound2001

NationalHealth

6(costs)15

(effects)


ofHCV-positive

swith

moderate

CHCreceivetreatm


IDUsin

contact


ars

32

HCV

preva

lence

mdash46707(23598)

NHSRampD

HTA

Programme

Services(N

HS)

Allscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm


Genito-urinary

medicineclinic

attendeesmeanage

36ye

ars15

HCVpreva

lence

mdash140471(77052)

UK

IDUsscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm

entIFN+RBV

32

HCVpreva

lence

mdash45076

aDependingontreatm



na=

notava



chain

reaction


















Conclusion


Acknowledgements


Funding





Key points






References





2006 91ndash135









20002017ndash35






200217423ndash30





200310285ndash93






1993119110ndash5



199313274ndash8






1999635ndash47














2008372321ndash32













15 May 2007)






20052147ndash54











httpwwwdestatisde






19996124ndash31















20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5







Introduction



















Methods





Results

Literature search













Table

1Lo

ng-term

effectiveness


untedlife

years

andorQALY

StudyCountry

Population

HCV

prevalence

()

ScreeningTreatm

ent

Incremental

life

years

(LYG)

Incremental

quality-adjusted

life

years

(QALY

)

Castelnuovo

etal36

Form

erIDUsmeanage37ye

ars

49


0058

0071



ars

125

presentationto


sreceive

0010

0017

NHSRampD

HTA

Programme

UK

Form

erandcu

rrentIDUsin

generalpracticemean

age37ye

ars

49

treatm

entPegIFN+RBV

0036

0071

Allpatients

assessedforHBVva

ccinationattending


ars

68

0066

0072

Prisoners


ars

(general

counseling)

16

0013

0022

Prisoners


ars

(counseling

withIDU

focu

s)

42

0036

0058

JusotandColin30

France


ars


entforHCV-positive

s

withKnodellscore

5IFN


00085

na

Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department


entforHCV-positive

s

withKnodellscore

5IFN


00004

na

Bloodrecipients




entsame

asabove

)

00030ndash0

0047a

na

Lealetal29

UK

IDUsin

contact


60


swithmoderate

toseve

re

CHCreceivetreatm

entIFN

na

0015b

Plunkett

etal35

USA


ars


(screened)or20

(unscreened)of

HCV-positive

swithmoderate

CHCreceivetreatm

ent

PegIFN+RBV

na

000011

1Screeningandtreatm

entasabove

plusCaesariandelive

ryna

00001

Stein

etal20

(Stein

etal20033334)

IDUsin

contact


ars

32


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

001003b

NHSRampD

HTA

Programme

UK

Genito-urinary

medicineclinic


ars

15


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

000047b

aRangereportedin


ndandthirdye

ar

bCalculatedwithdata


na=

notava



chain

reaction















Discussion










Table

2Disco

untedincrementalco


untedincrementalco


StudyCountry

CurrencyYear

Perspective

Disco

unt

rate

()

Comparator

TargetPopulation

ICER

(ELYG)

ICUR

(EQ

ALY

)

Castelnuovo

etal36

(ThompsonCoon

UKpound2004

NationalHealth

6(costs)15

(effects)



screeningpossible)

Form


ars49

HCV

preva

lence

30232

24858

etal37)

Services(N

HS)

HCV-positive

sreceivetreatm

entPegIFN+RBV


ars125

HCVpreva

lence

38633

23321

NHSRampD

HTA

Programme

Form

erandcu

rrentIDUsin


37ye

ars49

HCV

preva

lence

30194

24827

UK

Allpatients

assessedforHBVva



ars68

HCV

preva

lence

28689

26365


onHCV)

Prisoners


ars16

HCVpreva

lence

50833

30231


withfocu

sonIDU

andrisk

ofHCV)

Prisoners


ars42

HCVpreva

lence

40301

24813

JusotandColin30

France

FF1996Health

care

system

30ye

ars

time

Nodisco

unt

rate


ent

forHCV-positive

swithKnodellscore

5IFN

vs



ars3

HCV

preva

lence

140674

mdash

horizo


ent

forHCV-positive

swithKnodellscore

5IFN

vs


Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department

3

HCV

preva

lence

477654

mdash


andaftertransfusion

(treatm

entsameasabove

)

Bloodrecipients


3

HCV

preva

lence

144970

mdash

Lealetal29

UKpound1997na


swithmoderate

IDUsin

contact

withdrugservices60

HCV

preva

lence

mdash119754

UK

toseve

reCHCreceivetreatm

entIFN

(IFN

+RBV)

(18267-34537a)

Loubiere

etal32

France

E1998Health

care

system


ent

50

ofCHCcasesand40


treatm

entIFN+RBV

IDUs80

HCV

preva

lence

3881

mdash


ent

treatm

entasabove

9742

mdash


entif

cirrhosistreatm

entasabove

Patients

transfusedbefore

19917

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

243737

mdash


entif

cirrhosistreatm

entasabove

GeneralFrench

population12

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

5005

mdash

Plunkett

etal35

USA

US$

2003Health

care

system


sreceivetreatm

ent

PegIFN+RBV

Pregnantwomen1

HCV

preva

lence

mdashNoscreening

dominant

Asabove

plusCaesariandelive

rymdash

1150976

Singeretal31

USA

US$

2001S

ocietal


ofHCV-positive

sreceive

treatm

entIFN+RBV

Asymptomatic

ave

ragerisk

adultsmeanage35ye

ars

38

HCV

preva

lence

mdashNoscreening

dominant

Stein

etal20

(Stein

etal3334)

UKpound2001

NationalHealth

6(costs)15

(effects)


ofHCV-positive

swith

moderate

CHCreceivetreatm


IDUsin

contact


ars

32

HCV

preva

lence

mdash46707(23598)

NHSRampD

HTA

Programme

Services(N

HS)

Allscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm


Genito-urinary

medicineclinic

attendeesmeanage

36ye

ars15

HCVpreva

lence

mdash140471(77052)

UK

IDUsscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm

entIFN+RBV

32

HCVpreva

lence

mdash45076

aDependingontreatm



na=

notava



chain

reaction


















Conclusion


Acknowledgements


Funding





Key points






References





2006 91ndash135









20002017ndash35






200217423ndash30





200310285ndash93






1993119110ndash5



199313274ndash8






1999635ndash47














2008372321ndash32













15 May 2007)






20052147ndash54











httpwwwdestatisde






19996124ndash31















20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5





Methods





Results

Literature search













Table

1Lo

ng-term

effectiveness


untedlife

years

andorQALY

StudyCountry

Population

HCV

prevalence

()

ScreeningTreatm

ent

Incremental

life

years

(LYG)

Incremental

quality-adjusted

life

years

(QALY

)

Castelnuovo

etal36

Form

erIDUsmeanage37ye

ars

49


0058

0071



ars

125

presentationto


sreceive

0010

0017

NHSRampD

HTA

Programme

UK

Form

erandcu

rrentIDUsin

generalpracticemean

age37ye

ars

49

treatm

entPegIFN+RBV

0036

0071

Allpatients

assessedforHBVva

ccinationattending


ars

68

0066

0072

Prisoners


ars

(general

counseling)

16

0013

0022

Prisoners


ars

(counseling

withIDU

focu

s)

42

0036

0058

JusotandColin30

France


ars


entforHCV-positive

s

withKnodellscore

5IFN


00085

na

Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department


entforHCV-positive

s

withKnodellscore

5IFN


00004

na

Bloodrecipients




entsame

asabove

)

00030ndash0

0047a

na

Lealetal29

UK

IDUsin

contact


60


swithmoderate

toseve

re

CHCreceivetreatm

entIFN

na

0015b

Plunkett

etal35

USA


ars


(screened)or20

(unscreened)of

HCV-positive

swithmoderate

CHCreceivetreatm

ent

PegIFN+RBV

na

000011

1Screeningandtreatm

entasabove

plusCaesariandelive

ryna

00001

Stein

etal20

(Stein

etal20033334)

IDUsin

contact


ars

32


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

001003b

NHSRampD

HTA

Programme

UK

Genito-urinary

medicineclinic


ars

15


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

000047b

aRangereportedin


ndandthirdye

ar

bCalculatedwithdata


na=

notava



chain

reaction















Discussion










Table

2Disco

untedincrementalco


untedincrementalco


StudyCountry

CurrencyYear

Perspective

Disco

unt

rate

()

Comparator

TargetPopulation

ICER

(ELYG)

ICUR

(EQ

ALY

)

Castelnuovo

etal36

(ThompsonCoon

UKpound2004

NationalHealth

6(costs)15

(effects)



screeningpossible)

Form


ars49

HCV

preva

lence

30232

24858

etal37)

Services(N

HS)

HCV-positive

sreceivetreatm

entPegIFN+RBV


ars125

HCVpreva

lence

38633

23321

NHSRampD

HTA

Programme

Form

erandcu

rrentIDUsin


37ye

ars49

HCV

preva

lence

30194

24827

UK

Allpatients

assessedforHBVva



ars68

HCV

preva

lence

28689

26365


onHCV)

Prisoners


ars16

HCVpreva

lence

50833

30231


withfocu

sonIDU

andrisk

ofHCV)

Prisoners


ars42

HCVpreva

lence

40301

24813

JusotandColin30

France

FF1996Health

care

system

30ye

ars

time

Nodisco

unt

rate


ent

forHCV-positive

swithKnodellscore

5IFN

vs



ars3

HCV

preva

lence

140674

mdash

horizo


ent

forHCV-positive

swithKnodellscore

5IFN

vs


Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department

3

HCV

preva

lence

477654

mdash


andaftertransfusion

(treatm

entsameasabove

)

Bloodrecipients


3

HCV

preva

lence

144970

mdash

Lealetal29

UKpound1997na


swithmoderate

IDUsin

contact

withdrugservices60

HCV

preva

lence

mdash119754

UK

toseve

reCHCreceivetreatm

entIFN

(IFN

+RBV)

(18267-34537a)

Loubiere

etal32

France

E1998Health

care

system


ent

50

ofCHCcasesand40


treatm

entIFN+RBV

IDUs80

HCV

preva

lence

3881

mdash


ent

treatm

entasabove

9742

mdash


entif

cirrhosistreatm

entasabove

Patients

transfusedbefore

19917

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

243737

mdash


entif

cirrhosistreatm

entasabove

GeneralFrench

population12

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

5005

mdash

Plunkett

etal35

USA

US$

2003Health

care

system


sreceivetreatm

ent

PegIFN+RBV

Pregnantwomen1

HCV

preva

lence

mdashNoscreening

dominant

Asabove

plusCaesariandelive

rymdash

1150976

Singeretal31

USA

US$

2001S

ocietal


ofHCV-positive

sreceive

treatm

entIFN+RBV

Asymptomatic

ave

ragerisk

adultsmeanage35ye

ars

38

HCV

preva

lence

mdashNoscreening

dominant

Stein

etal20

(Stein

etal3334)

UKpound2001

NationalHealth

6(costs)15

(effects)


ofHCV-positive

swith

moderate

CHCreceivetreatm


IDUsin

contact


ars

32

HCV

preva

lence

mdash46707(23598)

NHSRampD

HTA

Programme

Services(N

HS)

Allscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm


Genito-urinary

medicineclinic

attendeesmeanage

36ye

ars15

HCVpreva

lence

mdash140471(77052)

UK

IDUsscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm

entIFN+RBV

32

HCVpreva

lence

mdash45076

aDependingontreatm



na=

notava



chain

reaction


















Conclusion


Acknowledgements


Funding





Key points






References





2006 91ndash135









20002017ndash35






200217423ndash30





200310285ndash93






1993119110ndash5



199313274ndash8






1999635ndash47














2008372321ndash32













15 May 2007)






20052147ndash54











httpwwwdestatisde






19996124ndash31















20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5



Table

1Lo

ng-term

effectiveness


untedlife

years

andorQALY

StudyCountry

Population

HCV

prevalence

()

ScreeningTreatm

ent

Incremental

life

years

(LYG)

Incremental

quality-adjusted

life

years

(QALY

)

Castelnuovo

etal36

Form

erIDUsmeanage37ye

ars

49


0058

0071



ars

125

presentationto


sreceive

0010

0017

NHSRampD

HTA

Programme

UK

Form

erandcu

rrentIDUsin

generalpracticemean

age37ye

ars

49

treatm

entPegIFN+RBV

0036

0071

Allpatients

assessedforHBVva

ccinationattending


ars

68

0066

0072

Prisoners


ars

(general

counseling)

16

0013

0022

Prisoners


ars

(counseling

withIDU

focu

s)

42

0036

0058

JusotandColin30

France


ars


entforHCV-positive

s

withKnodellscore

5IFN


00085

na

Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department


entforHCV-positive

s

withKnodellscore

5IFN


00004

na

Bloodrecipients




entsame

asabove

)

00030ndash0

0047a

na

Lealetal29

UK

IDUsin

contact


60


swithmoderate

toseve

re

CHCreceivetreatm

entIFN

na

0015b

Plunkett

etal35

USA


ars


(screened)or20

(unscreened)of

HCV-positive

swithmoderate

CHCreceivetreatm

ent

PegIFN+RBV

na

000011

1Screeningandtreatm

entasabove

plusCaesariandelive

ryna

00001

Stein

etal20

(Stein

etal20033334)

IDUsin

contact


ars

32


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

001003b

NHSRampD

HTA

Programme

UK

Genito-urinary

medicineclinic


ars

15


ofHCV-positive

swithmoderate

CHCreceivetreatm

entIFN+RBV

na

000047b

aRangereportedin


ndandthirdye

ar

bCalculatedwithdata


na=

notava



chain

reaction















Discussion










Table

2Disco

untedincrementalco


untedincrementalco


StudyCountry

CurrencyYear

Perspective

Disco

unt

rate

()

Comparator

TargetPopulation

ICER

(ELYG)

ICUR

(EQ

ALY

)

Castelnuovo

etal36

(ThompsonCoon

UKpound2004

NationalHealth

6(costs)15

(effects)



screeningpossible)

Form


ars49

HCV

preva

lence

30232

24858

etal37)

Services(N

HS)

HCV-positive

sreceivetreatm

entPegIFN+RBV


ars125

HCVpreva

lence

38633

23321

NHSRampD

HTA

Programme

Form

erandcu

rrentIDUsin


37ye

ars49

HCV

preva

lence

30194

24827

UK

Allpatients

assessedforHBVva



ars68

HCV

preva

lence

28689

26365


onHCV)

Prisoners


ars16

HCVpreva

lence

50833

30231


withfocu

sonIDU

andrisk

ofHCV)

Prisoners


ars42

HCVpreva

lence

40301

24813

JusotandColin30

France

FF1996Health

care

system

30ye

ars

time

Nodisco

unt

rate


ent

forHCV-positive

swithKnodellscore

5IFN

vs



ars3

HCV

preva

lence

140674

mdash

horizo


ent

forHCV-positive

swithKnodellscore

5IFN

vs


Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department

3

HCV

preva

lence

477654

mdash


andaftertransfusion

(treatm

entsameasabove

)

Bloodrecipients


3

HCV

preva

lence

144970

mdash

Lealetal29

UKpound1997na


swithmoderate

IDUsin

contact

withdrugservices60

HCV

preva

lence

mdash119754

UK

toseve

reCHCreceivetreatm

entIFN

(IFN

+RBV)

(18267-34537a)

Loubiere

etal32

France

E1998Health

care

system


ent

50

ofCHCcasesand40


treatm

entIFN+RBV

IDUs80

HCV

preva

lence

3881

mdash


ent

treatm

entasabove

9742

mdash


entif

cirrhosistreatm

entasabove

Patients

transfusedbefore

19917

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

243737

mdash


entif

cirrhosistreatm

entasabove

GeneralFrench

population12

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

5005

mdash

Plunkett

etal35

USA

US$

2003Health

care

system


sreceivetreatm

ent

PegIFN+RBV

Pregnantwomen1

HCV

preva

lence

mdashNoscreening

dominant

Asabove

plusCaesariandelive

rymdash

1150976

Singeretal31

USA

US$

2001S

ocietal


ofHCV-positive

sreceive

treatm

entIFN+RBV

Asymptomatic

ave

ragerisk

adultsmeanage35ye

ars

38

HCV

preva

lence

mdashNoscreening

dominant

Stein

etal20

(Stein

etal3334)

UKpound2001

NationalHealth

6(costs)15

(effects)


ofHCV-positive

swith

moderate

CHCreceivetreatm


IDUsin

contact


ars

32

HCV

preva

lence

mdash46707(23598)

NHSRampD

HTA

Programme

Services(N

HS)

Allscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm


Genito-urinary

medicineclinic

attendeesmeanage

36ye

ars15

HCVpreva

lence

mdash140471(77052)

UK

IDUsscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm

entIFN+RBV

32

HCVpreva

lence

mdash45076

aDependingontreatm



na=

notava



chain

reaction


















Conclusion


Acknowledgements


Funding





Key points






References





2006 91ndash135









20002017ndash35






200217423ndash30





200310285ndash93






1993119110ndash5



199313274ndash8






1999635ndash47














2008372321ndash32













15 May 2007)






20052147ndash54











httpwwwdestatisde






19996124ndash31















20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5
















Discussion










Table

2Disco

untedincrementalco


untedincrementalco


StudyCountry

CurrencyYear

Perspective

Disco

unt

rate

()

Comparator

TargetPopulation

ICER

(ELYG)

ICUR

(EQ

ALY

)

Castelnuovo

etal36

(ThompsonCoon

UKpound2004

NationalHealth

6(costs)15

(effects)



screeningpossible)

Form


ars49

HCV

preva

lence

30232

24858

etal37)

Services(N

HS)

HCV-positive

sreceivetreatm

entPegIFN+RBV


ars125

HCVpreva

lence

38633

23321

NHSRampD

HTA

Programme

Form

erandcu

rrentIDUsin


37ye

ars49

HCV

preva

lence

30194

24827

UK

Allpatients

assessedforHBVva



ars68

HCV

preva

lence

28689

26365


onHCV)

Prisoners


ars16

HCVpreva

lence

50833

30231


withfocu

sonIDU

andrisk

ofHCV)

Prisoners


ars42

HCVpreva

lence

40301

24813

JusotandColin30

France

FF1996Health

care

system

30ye

ars

time

Nodisco

unt

rate


ent

forHCV-positive

swithKnodellscore

5IFN

vs



ars3

HCV

preva

lence

140674

mdash

horizo


ent

forHCV-positive

swithKnodellscore

5IFN

vs


Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department

3

HCV

preva

lence

477654

mdash


andaftertransfusion

(treatm

entsameasabove

)

Bloodrecipients


3

HCV

preva

lence

144970

mdash

Lealetal29

UKpound1997na


swithmoderate

IDUsin

contact

withdrugservices60

HCV

preva

lence

mdash119754

UK

toseve

reCHCreceivetreatm

entIFN

(IFN

+RBV)

(18267-34537a)

Loubiere

etal32

France

E1998Health

care

system


ent

50

ofCHCcasesand40


treatm

entIFN+RBV

IDUs80

HCV

preva

lence

3881

mdash


ent

treatm

entasabove

9742

mdash


entif

cirrhosistreatm

entasabove

Patients

transfusedbefore

19917

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

243737

mdash


entif

cirrhosistreatm

entasabove

GeneralFrench

population12

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

5005

mdash

Plunkett

etal35

USA

US$

2003Health

care

system


sreceivetreatm

ent

PegIFN+RBV

Pregnantwomen1

HCV

preva

lence

mdashNoscreening

dominant

Asabove

plusCaesariandelive

rymdash

1150976

Singeretal31

USA

US$

2001S

ocietal


ofHCV-positive

sreceive

treatm

entIFN+RBV

Asymptomatic

ave

ragerisk

adultsmeanage35ye

ars

38

HCV

preva

lence

mdashNoscreening

dominant

Stein

etal20

(Stein

etal3334)

UKpound2001

NationalHealth

6(costs)15

(effects)


ofHCV-positive

swith

moderate

CHCreceivetreatm


IDUsin

contact


ars

32

HCV

preva

lence

mdash46707(23598)

NHSRampD

HTA

Programme

Services(N

HS)

Allscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm


Genito-urinary

medicineclinic

attendeesmeanage

36ye

ars15

HCVpreva

lence

mdash140471(77052)

UK

IDUsscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm

entIFN+RBV

32

HCVpreva

lence

mdash45076

aDependingontreatm



na=

notava



chain

reaction


















Conclusion


Acknowledgements


Funding





Key points






References





2006 91ndash135









20002017ndash35






200217423ndash30





200310285ndash93






1993119110ndash5



199313274ndash8






1999635ndash47














2008372321ndash32













15 May 2007)






20052147ndash54











httpwwwdestatisde






19996124ndash31















20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5



Table

2Disco

untedincrementalco


untedincrementalco


StudyCountry

CurrencyYear

Perspective

Disco

unt

rate

()

Comparator

TargetPopulation

ICER

(ELYG)

ICUR

(EQ

ALY

)

Castelnuovo

etal36

(ThompsonCoon

UKpound2004

NationalHealth

6(costs)15

(effects)



screeningpossible)

Form


ars49

HCV

preva

lence

30232

24858

etal37)

Services(N

HS)

HCV-positive

sreceivetreatm

entPegIFN+RBV


ars125

HCVpreva

lence

38633

23321

NHSRampD

HTA

Programme

Form

erandcu

rrentIDUsin


37ye

ars49

HCV

preva

lence

30194

24827

UK

Allpatients

assessedforHBVva



ars68

HCV

preva

lence

28689

26365


onHCV)

Prisoners


ars16

HCVpreva

lence

50833

30231


withfocu

sonIDU

andrisk

ofHCV)

Prisoners


ars42

HCVpreva

lence

40301

24813

JusotandColin30

France

FF1996Health

care

system

30ye

ars

time

Nodisco

unt

rate


ent

forHCV-positive

swithKnodellscore

5IFN

vs



ars3

HCV

preva

lence

140674

mdash

horizo


ent

forHCV-positive

swithKnodellscore

5IFN

vs


Bloodrecipients

40ndash6

5ye

ars



din

asurgery

department

3

HCV

preva

lence

477654

mdash


andaftertransfusion

(treatm

entsameasabove

)

Bloodrecipients


3

HCV

preva

lence

144970

mdash

Lealetal29

UKpound1997na


swithmoderate

IDUsin

contact

withdrugservices60

HCV

preva

lence

mdash119754

UK

toseve

reCHCreceivetreatm

entIFN

(IFN

+RBV)

(18267-34537a)

Loubiere

etal32

France

E1998Health

care

system


ent

50

ofCHCcasesand40


treatm

entIFN+RBV

IDUs80

HCV

preva

lence

3881

mdash


ent

treatm

entasabove

9742

mdash


entif

cirrhosistreatm

entasabove

Patients

transfusedbefore

19917

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

243737

mdash


entif

cirrhosistreatm

entasabove

GeneralFrench

population12

HCV

preva

lence

Dominatedby

EIA3+PCR

mdash


entif

cirrhosistreatm

entasabove

5005

mdash

Plunkett

etal35

USA

US$

2003Health

care

system


sreceivetreatm

ent

PegIFN+RBV

Pregnantwomen1

HCV

preva

lence

mdashNoscreening

dominant

Asabove

plusCaesariandelive

rymdash

1150976

Singeretal31

USA

US$

2001S

ocietal


ofHCV-positive

sreceive

treatm

entIFN+RBV

Asymptomatic

ave

ragerisk

adultsmeanage35ye

ars

38

HCV

preva

lence

mdashNoscreening

dominant

Stein

etal20

(Stein

etal3334)

UKpound2001

NationalHealth

6(costs)15

(effects)


ofHCV-positive

swith

moderate

CHCreceivetreatm


IDUsin

contact


ars

32

HCV

preva

lence

mdash46707(23598)

NHSRampD

HTA

Programme

Services(N

HS)

Allscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm


Genito-urinary

medicineclinic

attendeesmeanage

36ye

ars15

HCVpreva

lence

mdash140471(77052)

UK

IDUsscreened50

ofHCV-positive

swithmoderate

CHC

receivetreatm

entIFN+RBV

32

HCVpreva

lence

mdash45076

aDependingontreatm



na=

notava



chain

reaction


















Conclusion


Acknowledgements


Funding





Key points






References





2006 91ndash135









20002017ndash35






200217423ndash30





200310285ndash93






1993119110ndash5



199313274ndash8






1999635ndash47














2008372321ndash32













15 May 2007)






20052147ndash54











httpwwwdestatisde






19996124ndash31















20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5



















Conclusion


Acknowledgements


Funding





Key points






References





2006 91ndash135









20002017ndash35






200217423ndash30





200310285ndash93






1993119110ndash5



199313274ndash8






1999635ndash47














2008372321ndash32













15 May 2007)






20052147ndash54











httpwwwdestatisde






19996124ndash31















20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5




Key points






References





2006 91ndash135









20002017ndash35






200217423ndash30





200310285ndash93






1993119110ndash5



199313274ndash8






1999635ndash47














2008372321ndash32













15 May 2007)






20052147ndash54











httpwwwdestatisde






19996124ndash31















20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5





20051921153ndash61
















200616185ndash92



2005352570ndash85











Report No 5 1999





20034143ndash50



200626282ndash93










1992340697ndash8














1997261ndash5



sroczynski g. et al. (2010) long-term effectiveness and cost ...€¦ · switzerland. is the best...

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