Population-Based Testing for Undiagnosed Hepatitis C: A Systematic Review of Economic Evaluations

• Published in: Applied health economics and health policy 2022-03, Vol.20 (2), p.171-183
• Main Authors: Carty, Paul G., Fawsitt, Christopher G., Gillespie, Paddy, Harrington, Patricia, O’Neill, Michelle, Smith, Susan M., Teljeur, Conor, Ryan, Mairin
• Format: Article
• Language: English
• Subjects: Age groups; Blood diseases; Content analysis; Cost analysis; Cost-Benefit Analysis; Costs; CRD; CRD42019127159; Credibility; Criteria; Data quality; Economic models; Economics; Effectiveness; Epidemiology; Grey literature; Health Administration; Health care delivery; Health care expenditures; Health Economics; Health risks; Health services; Hepacivirus; Hepatitis; Hepatitis C; Hepatitis C - diagnosis; Hepatitis C - economics; Hepatitis C, Chronic; Homeless people; Humans; Industrialized nations; Infections; Inflation; Jurisdiction; Liver cancer; Medicine; Medicine & Public Health; Organizational effectiveness; Pharmacoeconomics and Health Outcomes; Population; Public Health; Purchasing power parity; Quality of Life Research; Serology; Systematic Review; Treatment outcomes; Viruses
• ISSN: 1175-5652; 1179-1896
• DOI: 10.1007/s40258-021-00694-w

Background and Objectives Recognising the significant public health threat posed by hepatitis C, international targets have been established by the World Health Organization with the aim of eradicating the hepatitis C virus (HCV) by 2030. With the availability of safe and effective therapies, the greatest challenge to achieving elimination is the identification and treatment of those currently undiagnosed. This systematic review aimed to identify and appraise the international literature on the cost-effectiveness of birth cohort, universal, and age-based general population testing for identifying people with undiagnosed chronic HCV infection. Methods A comprehensive literature search was undertaken in Medline, Embase and grey literature sources to identify studies published between 1 January 2000 and 17 July 2020. Retrieved citations were independently reviewed by two reviewers according to pre-defined eligibility criteria. Data extraction and critical appraisal were completed in duplicate. Study quality, relevance and credibility were assessed using the Consensus for Health Economic Criteria and the ISPOR questionnaires. All costs were reported in 2019 Irish Euro following adjustment for inflation and purchasing power parity. Willingness-to-pay (WTP) thresholds of €20,000 and €45,000 were adopted as reference points for interpreting cost-effectiveness in the narrative synthesis. The systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Results Overall, 4622 citations were retrieved in the literature search. Of these, 27 studies met the inclusion criteria. Six (22%) of the 27 studies were rated as low quality, 17 (63%) were moderate quality and four (15%) were high quality. Compared with no testing or risk-based testing: 14 of 16 (88%) cost-utility analyses found that birth cohort testing was cost effective, eight of nine (89%) analyses found that universal testing was cost effective, and eight of eight (100%) analyses found that age-based general population testing was cost effective. Cost effectiveness was influenced by disease prevalence and progression, testing and treatment uptake, treatment eligibility of those identified by testing, the cost of treatment and the proportion of those treated that achieve sustained virological response. Conclusion Overall, the international evidence supports the potential cost effectiveness of birth cohort, universal, and age-based general p