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The emergency department as a setting-specific opportunity for population-based hepatitis C screening: An economic evaluation.

Authors :
Mendlowitz AB
Naimark D
Wong WWL
Capraru C
Feld JJ
Isaranuwatchai W
Krahn M
Source :
Liver international : official journal of the International Association for the Study of the Liver [Liver Int] 2020 Jun; Vol. 40 (6), pp. 1282-1291. Date of Electronic Publication: 2020 Apr 30.
Publication Year :
2020

Abstract

Background and Aims: The World Health Organization's hepatitis C virus (HCV) elimination strategy recognizes the need for interventions that identify populations most affected by infection. The emergency department (ED) has been suggested as a setting for HCV screening. The study objective was to explore the health and economic impact of HCV screening in the ED setting.<br />Methods: We used a microsimulation model to conduct a cost-utility analysis evaluating two ED setting-specific strategies: no screening, and screening and subsequent treatment. Strategies were examined for two populations: (a) the general ED patient population; and (b) ED patients born between 1945 and 1975. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon. A reference and high ED HCV seroprevalence measure were examined in the Canadian healthcare setting.US costs of chronic infection were used for a scenario analysis of screening in the US healthcare setting.<br />Results: For birth cohort screening, in comparison to no screening, one liver-related death was averted for every 760 and 123 persons screened for the reference and high seroprevalence measures. For general population screening, one liver-related death was averted for every 831 and 147 persons screened for the reference and high seroprevalence measures. In comparison to no screening, birth cohort screening was cost-effective at CAN$25,584/quality-adjusted life year (QALY) and US$42,615/QALY. General population screening was cost-effective at CAN$19,733/QALY and US$32,187/QALY.<br />Conclusions: ED screening may represent a cost-effective component of population-based strategies to eliminate HCV. Further studies are warranted to explore the feasibility and acceptability of this approach.<br /> (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Details

Language :
English
ISSN :
1478-3231
Volume :
40
Issue :
6
Database :
MEDLINE
Journal :
Liver international : official journal of the International Association for the Study of the Liver
Publication Type :
Academic Journal
Accession number :
32267604
Full Text :
https://doi.org/10.1111/liv.14458