Cost-effectiveness and budget impact analysis of facility-based screening and treatment of hepatitis C in Punjab state of India

ObjectiveDespite treatment availability, chronic hepatitis C virus (HCV) public health burden is rising in India due to lack of timely diagnosis. Therefore, we aim to assess incremental cost per quality-adjusted life year (QALY) for one-time universal screening followed by treatment of people infected with HCV as compared with a no screening policy in Punjab, India.Study designDecision tree integrated with Markov model was developed to simulate disease progression. A societal perspective and a 3% annual discount rate were considered to assess incremental cost per QALY gained. In addition, budgetary impact was also assessed with a payer’s perspective and time horizon of 5 years.Study settingScreening services were assumed to be delivered as a facility-based intervention where active screening for HCV cases would be performed at 22 district hospitals in the state of Punjab, which will act as integrated testing as well as treatment sites for HCV.InterventionTwo intervention scenarios were compared with no universal screening and treatment (routine care). Scenario I—screening with ELISA followed by confirmatory HCV-RNA quantification and treatment. Scenario II—screening with rapid diagnostic test (RDT) kit followed by confirmatory HCV-RNA quantification and treatment.Primary and secondary outcome measuresLifetime costs; life years and QALY gained; and incremental cost-effectiveness ratio for each of the above-mentioned intervention scenario as compared with the routine care.ResultsScreening with ELISA and RDT, respectively, results in a gain of 0.028 (0.008 to 0.06) and 0.027 (0.008 to 0.061) QALY per person with costs decreased by −1810 Indian rupees (−3376 to –867) and −1812 Indian rupees (−3468 to −850) when compared with no screening. One-time universal screening of all those ≥18 years at a base coverage of 30%, with ELISA and RDT, would cost 8.5 and 8.3 times more, respectively, when compared with screening the age group of the cohort 40–45 years old.ConclusionOne-time universal screening followed by HCV treatment is a dominant strategy as compared with no screening. However, budget impact of screening of all ≥18-year-old people seems unsustainable. Thus, in view of findings from both cost-effectiveness and budget impact, we recommend beginning with screening the age cohort with RDT around mean age of disease presentation, that is, 40–45 years, instead of all ≥18-year-old people.

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Cost-effectiveness and budget impact of interferon-free direct-acting antiviral-based regimens for hepatitis C treatment: the French case

Journal of Viral Hepatitis ◽

10.1111/jvh.12546 ◽

2016 ◽

Vol 23 (10) ◽

pp. 767-779 ◽

Cited By ~ 23

Author(s):

S. Deuffic-Burban ◽

D. Obach ◽

V. Canva ◽

S. Pol ◽

F. Roudot-Thoraval ◽

...

Keyword(s):

Cost Effectiveness ◽

Hepatitis C ◽

Budget Impact ◽

Hepatitis C Treatment ◽

Direct Acting Antiviral ◽

French Case ◽

Direct Acting

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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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Effect of Multiple Freeze-Thaw Cycles on Hepatitis B Virus DNA and Hepatitis C Virus RNA Quantification as Measured with Branched-DNA Technology

Journal of Clinical Microbiology ◽

10.1128/jcm.37.6.1683-1686.1999 ◽

1999 ◽

Vol 37 (6) ◽

pp. 1683-1686 ◽

Cited By ~ 31

Author(s):

Mel Krajden ◽

James M. Minor ◽

Oretta Rifkin ◽

Lorraine Comanor

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Hepatitis B Virus ◽

Hepatitis B ◽

Hbv Dna ◽

Hcv Rna ◽

Freeze Thaw ◽

Rna Quantification ◽

B Virus ◽

Rna Levels

Quantification of hepatitis B virus (HBV) DNA and hepatitis C virus (HCV) RNA often is performed in specimens that have been frozen and thawed more than once. To ensure optimal therapeutic and prognostic value, it is important to establish whether viral load measurements are affected by repeated freeze-thaw (FT) cycles. We therefore evaluated the effect of multiple FT cycles on HBV DNA and HCV RNA quantification by testing serum specimens subjected to one (baseline), two, four, and eight FT cycles with the appropriate Chiron Quantiplex assay. Linear regression analysis showed minor increases of 1.7% per FT cycle for both HBV DNA and HCV RNA. The rise in HCV RNA levels was more pronounced among low-concentration samples, since further analysis revealed an increase of 3.2% per FT cycle among samples with 0.2 to 3.86 Meq of HCV RNA per ml. Given that the coefficient of variation for the Quantiplex assays is generally 10 to 15%, the minor increases in HBV DNA and HCV RNA levels with progressive FT cycles for the specimens tested were recognized only because analysis of variance revealed a statistically significant trend (P < 0.05). Due to the minor statistical trend, the clinical impact for individual patient specimens is likely to be limited, but it may deserve further study. In conclusion, the concentration of HBV DNA and HCV RNA in serum specimens subjected to up to eight short-term FT cycles was stable.

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A cost-effectiveness study of universal screening for hepatitis C virus infection in South Korea: A societal perspective

Clinical and Molecular Hepatology ◽

10.3350/cmh.2021.0236 ◽

2021 ◽

Author(s):

Hye-Lin Kim ◽

Kyung-Ah Kim ◽

Gwang Hyun Choi ◽

Eun Sun Jang ◽

Moran Ki ◽

...

Keyword(s):

Hepatitis C Virus ◽

Cost Effectiveness ◽

Hepatitis C ◽

Virus Infection ◽

South Korea ◽

Societal Perspective ◽

Universal Screening ◽

Effectiveness Study ◽

Hepatitis C Virus Infection ◽

Cost Effectiveness Study

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Pragmatic Experience with Risk-based versus Universal Hepatitis C Screening in Pregnancy: Detection of Infection and Postpartum Linkage to Care

American Journal of Perinatology ◽

10.1055/s-0041-1728827 ◽

2021 ◽

Author(s):

Elisa T. Bushman ◽

Lakshmi Subramani ◽

Aalok Sanjanwala ◽

Jodie Dionne-Odom ◽

Ricardo Franco ◽

...

Keyword(s):

Hepatitis C ◽

Pregnant Women ◽

Universal Screening ◽

Task Force ◽

Care Center ◽

Tertiary Care ◽

Linkage To Care ◽

Hcv Rna ◽

Hcv Screening ◽

In Pregnancy

Objective Despite the Centers for Disease Control and Prevention (CDC) and U.S. Preventive Services Task Force (USPSTF) recommending universal hepatitis C virus (HCV) screening in pregnancy Society for Maternal-Fetal Medicine (SMFM) and American College of Obstetricians and Gynecologists (ACOG) continue to endorse risk-based screening for HCV in pregnancy. We hypothesized that universal screening is associated with increased HCV diagnosis and postpartum linkage to HCV care compared with risk-based screening. Study Design This retrospective cohort study included pregnant women screened for HCV at a single tertiary-care center. We defined two cohorts: women managed with risk-based (January 2014–October 2016) or universal HCV screening (November 2016–December 2018). Screening was performed with ELISA antibody testing and viremia confirmed with HCV ribonucleic acid (RNA) polymerase chain reaction (PCR). Primary outcomes were the rate of HCV screen positivity and postpartum linkage to care. Results From 2014 to 2018, 16,489 women delivered at our institution, of whom 166 screened positive for HCV. A total of 7,039 pregnant women were screened for HCV: 266 with risk-based and 6,773 with universal screening; 29% (76/266) were positive HCV antibody screening (HCVAb + ) in the risk-based cohort and 1.3% (90/6,773) in the universal cohort. HCVAb+ women in the risk-based cohort were more likely to have a positive drug screen. Only 69% (62/90) of HCVAb+ women in the universal cohort met the criteria for risk-based testing. Of the remaining 28 women, 6 (21%) had active viremia (HCV RNA+). Of the 166 HCVAb+ women, 64% (103/166) were HCV RNA+—51 of 266 (19%) in the risk-based and 52 of 6,773 (0.8%) in the universal cohort. Of HCVAb+ women, 75% (125/166) were referred postpartum for HCV evaluation and 27% (34/125) were linked to care. Only 9% (10/103) of women with viremia initiated treatment within 1 year of delivery. Conclusion Universal HCV screening in pregnancy identified an additional 31% of HCVAb+ women compared with risk-based screening. Given low rates of HCV follow-up and treatment regardless of screening modality, further studies are needed to address barriers to postpartum linkage to care. Key Points

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Liothyronine for hypothyroidism: a candidate for disinvestment or in need of further research? A value of information analysis

BMJ Open ◽

10.1136/bmjopen-2021-051702 ◽

2021 ◽

Vol 11 (12) ◽

pp. e051702

Author(s):

Dyfrig A Hughes ◽

Konstantinos Skiadas ◽

Deborah Fitzsimmons ◽

Pippa Anderson ◽

Adrian Heald

Keyword(s):

Cost Effectiveness ◽

Combination Therapy ◽

Incremental Cost ◽

Value Of Information ◽

Cost Utility ◽

Secondary Outcome ◽

Depression Symptoms ◽

Persistent Symptoms ◽

The Uk ◽

The Cost

ObjectiveMedicines with limited evidence of effectiveness are prime candidates for disinvestment. However, investment in further research may be preferable to deimplementation, given that the absence of evidence is not evidence of absence, and research can inform formulary decisions. A case in point is liothyronine, which is sometimes prescribed to levothyroxine-treated patients who continue to experience hypothyroid symptoms. It is a putative low value medicine, associated with uncertainties in both clinical and cost-effectiveness. The aim was to assess the cost-effectiveness of liothyronine in this context, and estimate the value of conducting further research.DesignCost utility and value of information analyses.SettingPrimary care within the National Health Service in the UK.ParticipantsFifty-four levothyroxine-treated patients with persistent symptoms of hypothyroidism.InterventionsLiothyronine plus levothyroxine versus levothyroxine alone.Primary and secondary outcome measuresIncremental cost per quality-adjusted life year (QALY) gained, and the expected monetary value of sample information.Results20/54 (37%) of patients who responded to the survey reported severe problems in carrying out usual activities of everyday living and 12/54 (22%) reported severe anxiety or depression symptoms. Mean (SD) utility was 0.53 (0.23). The differences in expected total, 10-year costs and QALYs between a treatment strategy of liothyronine/levothyroxine combination therapy, and levothyroxine alone, was £12 053 and 1.014, respectively. The incremental cost-effectiveness ratio of £11 881 per QALY gained was sensitive to the price of liothyronine. The probability of liothyronine/levothyroxine combination therapy being cost effective at a threshold of £20 000 per QALY was 0.56. The value of reducing uncertainty in the efficacy of treatment was £3.64 m per year in the UK.ConclusionsA definitive clinical trial to confirm clinical effectiveness may be preferable to immediate disinvestment, and would be justified given the value of the information gained far exceeds the cost.

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Short-term and long-term cost-effectiveness of a pedometer-based exercise intervention in primary care: a within-trial analysis and beyond-trial modelling

BMJ Open ◽

10.1136/bmjopen-2018-021978 ◽

2018 ◽

Vol 8 (10) ◽

pp. e021978 ◽

Cited By ~ 2

Author(s):

Nana Anokye ◽

Julia Fox-Rushby ◽

Sabina Sanghera ◽

Derek G Cook ◽

Elizabeth Limb ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Health Service ◽

Incremental Cost ◽

Service Use ◽

Cost Effective ◽

Health Service Use ◽

Secondary Outcome ◽

Short Term

ObjectivesA short-term and long-term cost-effectiveness analysis (CEA) of two pedometer-based walking interventions compared with usual care.Design(A) Short-term CEA: parallel three-arm cluster randomised trial randomised by household. (B) Long-term CEA: Markov decision model.SettingSeven primary care practices in South London, UK.Participants(A) Short-term CEA: 1023 people (922 households) aged 45–75 years without physical activity (PA) contraindications. (b) Long-term CEA: a cohort of 100 000 people aged 59–88 years.InterventionsPedometers, 12-week walking programmes and PA diaries delivered by post or through three PA consultations with practice nurses.Primary and secondary outcome measuresAccelerometer-measured change (baseline to 12 months) in average daily step count and time in 10 min bouts of moderate to vigorous PA (MVPA), and EQ-5D-5L quality-adjusted life-years (QALY).MethodsResource use costs (£2013/2014) from a National Health Service perspective, presented as incremental cost-effectiveness ratios for each outcome over a 1-year and lifetime horizon, with cost-effectiveness acceptability curves and willingness to pay per QALY. Deterministic and probabilistic sensitivity analyses evaluate uncertainty.Results(A) Short-term CEA: At 12 months, incremental cost was £3.61 (£109)/min in ≥10 min MVPA bouts for nurse support compared with control (postal group). At £20 000/QALY, the postal group had a 50% chance of being cost saving compared with control. (B) Long-term CEA: The postal group had more QALYs (+759 QALYs, 95% CI 400 to 1247) and lower costs (−£11 million, 95% CI −12 to −10) than control and nurse groups, resulting in an incremental net monetary benefit of £26 million per 100 000 population. Results were sensitive to reporting serious adverse events, excluding health service use, and including all participant costs.ConclusionsPostal delivery of a pedometer intervention in primary care is cost-effective long term and has a 50% chance of being cost-effective, through resource savings, within 1 year. Further research should ascertain maintenance of the higher levels of PA, and its impact on quality of life and health service use.Trial registration numberISRCTN98538934; Pre-results.

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Tibial nerve decompression for the prevention of the diabetic foot: a cost–utility analysis using Markov model simulations

BMJ Open ◽

10.1136/bmjopen-2018-024816 ◽

2019 ◽

Vol 9 (3) ◽

pp. e024816 ◽

Cited By ~ 2

Author(s):

Samuel Sarmiento ◽

James A Pierre Jr ◽

A Lee Dellon ◽

Kevin D Frick

Keyword(s):

Cost Effectiveness ◽

Diabetic Neuropathy ◽

Markov Model ◽

Incremental Cost ◽

Outcome Measures ◽

Diabetic Foot ◽

Tibial Nerve ◽

Secondary Outcome ◽

Foot Ulcers

ObjectiveTo determine whether tibial neurolysis performed as a surgical intervention for patients with diabetic neuropathy and superimposed tibial nerve compression in the prevention of the diabetic foot is cost-effective when compared with the current prevention programme.DesignA baseline analysis was built on a 5-year model to determine the cumulative incidence of foot ulcers and amputations with each strategy. Subsequently, a cost-effectiveness analysis and cohort-level Markov simulations were conducted with a model composed of 20 6-month cycles. A sensitivity analysis was also performed.SettingA Markov model was used to simulate the effects of standard prevention compared with tibial neurolysis on the long-term costs associated with foot ulcers and amputations. This model included eight health states.ParticipantsEach cohort includes simulated patients with diabetic neuropathy at different levels of risk of developing foot ulcers and amputations.Primary and secondary outcome measuresThe primary outcome was the long-term trends concerning the development of ulcers and amputations with each strategy. The secondary outcome measures were quality adjusted life years (QALYs), incremental cost-effectiveness and net monetary benefits of the optimal strategy.ResultsWhen compared with standard prevention, for a patient population of 10 000, surgery prevented a simulated total of 1447 ulcers and 409 amputations over a period of 5 years. In a subsequent analysis that consisted of 20 6-month cycles (10 years), the incremental cost of tibial neurolysis compared with current prevention was $12 772.28; the incremental effectiveness was 0.41 QALYs and the incremental cost-effectiveness ratio was $31 330.78. Survival was 73% for those receiving medical prevention compared with 95% for those undergoing surgery.ConclusionThese results suggest that among patients with diabetic neuropathy and superimposed nerve compression, surgery is more effective at preventing serious comorbidities and is associated with a higher survival over time. It also generated greater long-term economic benefits.

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