Universal hepatitis C screening examined as cost effective in France

Universal screening for hepatitis C virus (HCV) is the most effective eradication strategy in France, according to new research published in the Journal of Hepatology.

“Screening, on an individual basis, enables rapid treatment, which avoids the development of serious complications,” said lead author, Sylvie Deuffic-Burban, PhD, Université Paris Diderot, Sorbonne Paris Cité, Paris. “In time, collective screening helps eliminate hepatitis C from a population that has been screened without restrictions.”

Currently in Europe, screening for HCV is recommended only for people at high infection risk. In 2014, this approach left 75,000 French people undiagnosed, representing about 40% of HCV infections in the country.

The authors argue for reconsidering current screening strategies for three reasons:

• In > 10% of patients, HCV is diagnosed at an advanced stage.
• HCV treatments are highly effective and tolerated.
• Rapid screening tests for HCV make it possible to screen patients outside of health-care facilities.

“Early detection can allow earlier introduction of antiviral treatment leading to a reduction in morbidity and mortality,” the authors wrote. “It can also allow a reduction in the cost of care, because an effective and early treatment may prevent progression to the costly complications, such as cirrhosis and/or hepatocellular carcinoma (HCC).”

In addition, early HCV detection and treatment can avert transmission—especially in high-risk populations—thus promoting societal benefit.

The team created a decision analysis model to assess life expectancy, life expectancy in discounted quality-adjusted life years, direct lifetime discounted costs, and incremental cost-effectiveness ratio, among French people aged between 18 and 80 years without chronic hepatitis C, for the following five HCV screening strategies:

• HCV screening offered to only high-risk individuals based on imperfect determination of risk factors (ie, the current strategy)
• The current strategy plus screening all French men ages 18 to 59
• The current strategy plus screening all French people ages 40 to 59
• The current strategy plus screening all French people ages 40 to 80
• Screening all French people ages 18 and 80 years (ie, universal screening)

Dr. Deuffic-Burban and colleagues characterized the study population based on the 2004 national seroprevalence survey of the French National Public Health agency.

“An extensive sensitivity analysis was conducted to evaluate the impact of assumptions or uncertainties around the data on the cost-effectiveness analysis considering only the case of treatment for all, and to determine the robustness of our overall conclusions,” the authors wrote.

The analysis determined the effectiveness and cost effectiveness of these five strategies. They found the most clinically effective strategy is universal screening in all French people aged 18 to 80. The following are 20-year incidences for clinical repercussions under universal screening vs the current strategy:

• 36% vs 3.03% for cirrhosis
• 92% vs 2.29% for decompensated cirrhosis
• 34% vs 2.54% for HCC
• 28% vs 5.76% for liver deaths

Moreover, universal screening is cost effective if patients testing positive for HCV receive rapid treatment after diagnosis.

The authors note certain limitations in the current study. For example, the mathematical models that they designed leveraged data from multiple sources. Also, their baseline analysis was rooted in limited health-related utility data, such as utility benefit from attaining sustained virologic response (SVR).

“In France,” the authors wrote, “when considering treatment for all, universal screening of all individuals aged 18 to 80 is the most effective strategy, as well as being cost-effective. From an individual and especially from a societal perspective of HCV eradication, this strategy should be implemented. However, when recommending such strategy, rapid initiation of treatment after diagnosis is required.”

Finally, the findings of the current HCV study might apply to other types of infectious disease.

“Although our model is unable to test the idea,” said Dr. Deuffic-Burban, “the epidemiological similarities of HCV, HIV, and HBV suggest that universal and combined screening for these three viruses could be of particular interest.”

This study was funded by the French Agence Nationale de Recherche sur le Sida et les Hépatites virales.

To read more about this study, click here.