Cost-effectiveness and Budgetary Impact of Hepatitis C Virus Testing, Treatment, and Linkage to Care in US Prisons

Abstract Background Hepatitis C virus (HCV) testing and treatment uptake in prisons remains low. We aimed to estimate clinical outcomes, cost-effectiveness (CE), and budgetary impact (BI) of HCV testing and treatment in United States (US) prisons or linkage to care at release. Methods We used individual-based simulation modeling with healthcare and Department of Corrections (DOC) perspectives for CE and BI analyses, respectively. We simulated a US prison cohort at entry using published data and Washington State DOC individual-level data. We considered permutations of testing (risk factor based, routine at entry or at release, no testing), treatment (if liver fibrosis stage ≥F3, for all HCV infected or no treatment), and linkage to care (at release or no linkage). Outcomes included quality-adjusted life-years (QALY); cases identified, treated, and cured; cirrhosis cases avoided; incremental cost-effectiveness ratios; DOC costs (2016 US dollars); and BI (healthcare cost/prison entrant) to generalize to other states. Results Compared to “no testing, no treatment, and no linkage to care,” the “test all, treat all, and linkage to care at release” model increased the lifetime sustained virologic response by 23%, reduced cirrhosis cases by 54% at a DOC annual additional cost of $1440 per prison entrant, and would be cost-effective. At current drug prices, targeted testing and liver fibrosis–based treatment provided worse outcomes at higher cost or worse outcomes at higher cost per QALY gained. In sensitivity analysis, fibrosis-based treatment restrictions were cost-effective at previous higher drug costs. Conclusions Although costly, widespread testing and treatment in prisons is considered to be of good value at current drug prices.

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Cost Effectiveness and Cost Containment in the Era of Interferon-Free Therapies to Treat Hepatitis C Virus Genotype 1

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw266 ◽

2016 ◽

Vol 4 (1) ◽

Cited By ~ 7

Author(s):

Benjamin P. Linas ◽

Jake R. Morgan ◽

Mai T. Pho ◽

Jared A. Leff ◽

Bruce R. Schackman ◽

...

Keyword(s):

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Cost Control ◽

Advanced Disease ◽

Cost Effective ◽

The United States ◽

Genotype 1 ◽

Virus Genotype ◽

Budgetary Impact

Abstract Background Interferon-free regimens to treat hepatitis C virus (HCV) genotype 1 are effective but costly. At this time, payers in the United States use strategies to control costs including (1) limiting treatment to those with advanced disease and (2) negotiating price discounts in exchange for exclusivity. Methods We used Monte Carlo simulation to investigate budgetary impact and cost effectiveness of these treatment policies and to identify strategies that balance access with cost control. Outcomes included nondiscounted 5-year payer cost per 10000 HCV-infected patients and incremental cost-effectiveness ratios. Results We found that the budgetary impact of HCV treatment is high, with 5-year undiscounted costs of $1.0 billion to 2.3 billion per 10000 HCV-infected patients depending on regimen choices. Among noncirrhotic patients, using the least costly interferon-free regimen leads to the lowest payer costs with negligible difference in clinical outcomes, even when the lower cost regimen is less convenient and/or effective. Among cirrhotic patients, more effective but costly regimens remain cost effective. Controlling costs by restricting treatment to those with fibrosis stage 2 or greater disease was cost ineffective for any patient type compared with treating all patients. Conclusions Treatment strategies using interferon-free therapies to treat all HCV-infected persons are cost effective, but short-term cost is high. Among noncirrhotic patients, using the least costly interferon-free regimen, even if it is not single tablet or once daily, is the cost-control strategy that results in best outcomes. Restricting treatment to patients with more advanced disease often results in worse outcomes than treating all patients, and it is not preferred.

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The Effectiveness and Cost-Effectiveness of Hepatitis C Screening for Migrants in the EU/EEA: A Systematic Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15092013 ◽

2018 ◽

Vol 15 (9) ◽

pp. 2013 ◽

Cited By ~ 12

Author(s):

Christina Greenaway ◽

Iuliia Makarenko ◽

Claire Abou Chakra ◽

Balqis Alabdulkarim ◽

Robin Christensen ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Lower Risk ◽

Linkage To Care ◽

Cost Effective ◽

Screening Tests ◽

European Economic Area ◽

The European Union ◽

Wide Range ◽

The Eu

Chronic hepatitis C (HCV) is a public health priority in the European Union/European Economic Area (EU/EEA) and is a leading cause of chronic liver disease and liver cancer. Migrants account for a disproportionate number of HCV cases in the EU/EEA (mean 14% of cases and >50% of cases in some countries). We conducted two systematic reviews (SR) to estimate the effectiveness and cost-effectiveness of HCV screening for migrants living in the EU/EEA. We found that screening tests for HCV are highly sensitive and specific. Clinical trials report direct acting antiviral (DAA) therapies are well-tolerated in a wide range of populations and cure almost all cases (>95%) and lead to an 85% lower risk of developing hepatocellular carcinoma and an 80% lower risk of all-cause mortality. At 2015 costs, DAA based regimens were only moderately cost-effective and as a result less than 30% of people with HCV had been screened and less 5% of all HCV cases had been treated in the EU/EEA in 2015. Migrants face additional barriers in linkage to care and treatment due to several patient, practitioner, and health system barriers. Although decreasing HCV costs have made treatment more accessible in the EU/EEA, HCV elimination will only be possible in the region if health systems include and treat migrants for HCV.

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The Cost-Effectiveness of Hepatitis C Virus Screening Strategies among Recently Arrived Migrants in the Netherlands

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176091 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6091

Author(s):

Mohamed N.M.T. Al Khayat ◽

Job F.H. Eijsink ◽

Maarten J. Postma ◽

Jan C. Wilschut ◽

Marinus van Hulst

Keyword(s):

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

The Netherlands ◽

Budget Impact ◽

Cost Effective ◽

Life Years ◽

Screening Strategies ◽

Hcv Screening ◽

The Cost

Objective: We aimed to assess the cost-effectiveness of hepatitis C virus (HCV) screening strategies among recently arrived migrants in the Netherlands. Methods: A Markov model was used to estimate the health effects and costs of HCV screening from the healthcare perspective. A cohort of 50,000 recently arrived migrants was used. In this cohort, three HCV screening strategies were evaluated: (i) no screening, (ii) screening of migrants from HCV-endemic countries and (iii) screening of all migrants. Results: Strategy (ii) screening of migrants from HCV-endemic countries compared to strategy (i) no screening, yielded an incremental cost-effectiveness ratio (ICER) of €971 per quality-adjusted life-years (QALYs) gained. Strategy (iii) screening of all migrants compared with strategy (ii) screening of migrants from HCV-endemic countries yielded an ICER of €1005 per QALY gained. The budget impact of strategy (ii) screening of migrants from HCV-endemic countries and strategy (iii) screening of all migrants was €13,752,039 and €20,786,683, respectively. Conclusion: HCV screening is cost-effective. However, the budget impact may have a strong influence on decision making.

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Expanded Hepatitis C Virus (HCV) Testing and Linkage to Care: Program Implementation to Overcome Barriers to Engagement in Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.307 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Rebecca Eavou ◽

Ellen Almirol ◽

Randee Estes ◽

Michelle Taylor ◽

Mai Pho ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Program Implementation ◽

Linkage To Care ◽

Care Program ◽

Engagement In Care ◽

Hcv Testing

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PIN9 A COST-EFFECTIVENESS ANALYSIS OF A YEARLY FIBROSCAN® LIVER FIBROSIS ASSESSMENT COMPARED WITH A PERIODIC LIVER BIOPSY IN HEPATITIS C VIRUS (HCV) INFECTED INDIVIDUALS IN A FRENCH SETTING

Value in Health ◽

10.1016/s1098-3015(10)65516-7 ◽

2007 ◽

Vol 10 (6) ◽

pp. A438

Author(s):

K Levesque ◽

V De Lédinghen ◽

M Bourlière ◽

H Miadi-Fargier ◽

S Billon ◽

...

Keyword(s):

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Liver Fibrosis ◽

Liver Biopsy ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis

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Using the electronic medical record to increase testing for HIV and hepatitis C virus in an Appalachian emergency department

BMC Health Services Research ◽

10.1186/s12913-021-06482-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Carmen N. Burrell ◽

Melinda J. Sharon ◽

Stephen Davis ◽

Judith Feinberg ◽

Elena M. Wojcik ◽

...

Keyword(s):

Emergency Department ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Medical Record ◽

Electronic Medical Record ◽

Best Practice ◽

Linkage To Care ◽

Patient Navigators ◽

Hcv Screening ◽

Hcv Testing

Abstract Background The ongoing Appalachian opioid epidemic has led to increasing hepatitis C virus (HCV) infections among people who inject drugs (PWID), and Human Immunodeficiency Virus (HIV) outbreaks have been observed. The primary aim of this study was to assess the potential increase in screening for HIV and HCV in an academic central Appalachian emergency department (ED) through the use of Best Practice Alerts (BPAs) in the electronic medical record (EMR). A secondary aim was to assess for an increase in linkage to care using patient navigators. Methods EMR algorithms based on current Centers for Disease Control and Prevention HIV and HCV testing recommendations were created that triggered Best Practice Alerts (BPAs), giving providers a one-click acceptance option to order HIV and/or HCV testing. Placards were placed in care areas, informing patients of the availability of routine screening. Patient navigators facilitated linkage to care for seropositive patients. Results The BPA appeared 58,936 times on 21,098 patients eligible for HIV screening and 24,319 times on 11,989 patients eligible for HCV screening over a one-year period. Of those, 7106 (33.7%) patients were screened for HIV and 3496 (29.2%) patients were screened for HCV, for an overall testing increase of 2269% and 1065% for HIV and HCV, respectively. Linkage to care increased by 15% for HIV to 100, and 14% for HCV to 64%. Conclusion HIV and HCV screening and linkage to care were increased in an academic ED setting in central Appalachia using EMR alerts. This approach could be utilized in multiple ambulatory settings. Increased testing and earlier linkage to care may help combat the current injection drug use-related HCV epidemic and avoid additional HIV outbreaks.

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Health and economic benefits of achieving hepatitis C virus elimination in Pakistan: A modelling study and economic analysis

PLoS Medicine ◽

10.1371/journal.pmed.1003818 ◽

2021 ◽

Vol 18 (10) ◽

pp. e1003818

Author(s):

Aaron G. Lim ◽

Nick Scott ◽

Josephine G. Walker ◽

Saeed Hamid ◽

Margaret Hellard ◽

...

Keyword(s):

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Healthcare Services ◽

Economic Benefits ◽

Healthcare Management ◽

Transmission Model ◽

Economic Productivity ◽

The Impact ◽

Hcv Testing

Background Modelling suggests that achieving the WHO incidence target for hepatitis C virus (HCV) elimination in Pakistan could cost US$3.87 billion over 2018 to 2030. However, the economic benefits from integrating services or improving productivity were not included. Methods and findings We adapt a HCV transmission model for Pakistan to estimate the impact, costs, and cost-effectiveness of achieving HCV elimination (reducing annual HCV incidence by 80% by 2030) with stand-alone service delivery, or partially integrating one-third of initial HCV testing into existing healthcare services. We estimate the net economic benefits by comparing the required investment in screening, treatment, and healthcare management to the economic productivity gains from reduced HCV-attributable absenteeism, presenteeism, and premature deaths. We also calculate the incremental cost-effectiveness ratio (ICER) per disability-adjusted life year (DALY) averted for HCV elimination versus maintaining current levels of HCV treatment. This is compared to an opportunity cost-based willingness-to-pay threshold for Pakistan (US$148 to US$198/DALY). Compared to existing levels of treatment, scaling up screening and treatment to achieve HCV elimination in Pakistan averts 5.57 (95% uncertainty interval (UI) 3.80 to 8.22) million DALYs and 333,000 (219,000 to 509,000) HCV-related deaths over 2018 to 2030. If HCV testing is partially integrated, this scale-up requires an investment of US$1.45 (1.32 to 1.60) billion but will result in US$1.30 (0.94 to 1.72) billion in improved economic productivity over 2018 to 2030. This elimination strategy is highly cost-effective (ICER = US$29 per DALY averted) by 2030, with it becoming cost-saving by 2031 and having a net economic benefit of US$9.10 (95% UI 6.54 to 11.99) billion by 2050. Limitations include uncertainty around what level of integration is possible within existing primary healthcare services as well as a lack of Pakistan-specific data on disease-related healthcare management costs or productivity losses due to HCV. Conclusions Investment in HCV elimination can bring about substantial societal health and economic benefits for Pakistan.

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Hepatitis C Virus Quantitation: Optimization of Strategies for Detecting Low-Level Viremia

Journal of Clinical Microbiology ◽

10.1128/jcm.38.2.888-891.2000 ◽

2000 ◽

Vol 38 (2) ◽

pp. 888-891 ◽

Cited By ~ 9

Author(s):

Wolfgang T. Hofgärtner ◽

Jeffrey A. Kant ◽

Karen E. Weck

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Medical Center ◽

Significant Proportion ◽

Cost Effective ◽

Hcv Rna ◽

Rt Pcr ◽

Pcr Assay ◽

Economic Implications ◽

Hcv Testing

A long-term assessment of quantitative hepatitis C virus (HCV) testing was performed at the University of Pittsburgh Medical Center. The Quantiplex HCV RNA 2.0 branched-chain DNA (bDNA) assay (Bayer Diagnostics) for hepatitis C viral load determination was used to test 3,471 specimens. bDNA-negative samples were also tested by an in-house qualitative reverse transcriptase (RT)-PCR assay with a measured sensitivity of fewer than 100 HCV genome equivalents per milliliter. Of 1,239 bDNA-negative specimens, 74.1% were negative and 25.9% were positive by RT-PCR, indicating the presence of viremia in a significant proportion of bDNA-negative samples. We discuss the medical and economic implications of these results and propose two alternatives for clinical laboratories to consider in approaching quantitative HCV testing. For laboratories able to perform a sensitive RT-PCR assay for ≤40% of the bDNA test cost, prescreening bDNA requests by RT-PCR may be the most cost-effective approach.

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Universal opt-out screening for hepatitis C virus (HCV) within correctional facilities is an effective intervention to improve public health

International Journal of Prisoner Health ◽

10.1108/ijph-07-2016-0028 ◽

2017 ◽

Vol 13 (3/4) ◽

pp. 192-199 ◽

Cited By ~ 16

Author(s):

Meghan D. Morris ◽

Brandon Brown ◽

Scott A. Allen

Keyword(s):

Public Health ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Cost Effective ◽

Correctional Facilities ◽

Content Type ◽

Opt Out ◽

The Usa ◽

Testing Policies ◽

Hcv Testing

Purpose Worldwide efforts to identify individuals infected with the hepatitis C virus (HCV) focus almost exclusively on community healthcare systems, thereby failing to reach high-risk populations and those with poor access to primary care. In the USA, community-based HCV testing policies and guidelines overlook correctional facilities, where HCV rates are believed to be as high as 40 percent. This is a missed opportunity: more than ten million Americans move through correctional facilities each year. Herein, the purpose of this paper is to examine HCV testing practices in the US correctional system, California and describe how universal opt-out HCV testing could expand early HCV detection, improve public health in correctional facilities and communities, and prove cost-effective over time. Design/methodology/approach A commentary on the value of standardizing screening programs across facilities by mandating all facilities (universal) to implement opt-out testing policies for all prisoners upon entry to the correctional facilities. Findings Current variability in facility-level testing programs results in inconsistent testing levels across correctional facilities, and therefore makes estimating the actual number of HCV-infected adults in the USA difficult. The authors argue that universal opt-out testing policies ensure earlier diagnosis of HCV among a population most affected by the disease and is more cost-effective than selective testing policies. Originality/value The commentary explores the current limitations of selective testing policies in correctional systems and provides recommendations and implications for public health and correctional organizations.

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