PT  - JOURNAL ARTICLE
AU  - Wong, William W.L.
AU  - Tu, Hong-Anh
AU  - Feld, Jordan J.
AU  - Wong, Tom
AU  - Krahn, Murray
TI  - Cost-effectiveness of screening for hepatitis C in Canada
AID  - 10.1503/cmaj.140711
DP  - 2015 Feb 17
TA  - Canadian Medical Association Journal
PG  - E110--E121
VI  - 187
IP  - 3
4099  - http://www.cmaj.ca/content/187/3/E110.short
4100  - http://www.cmaj.ca/content/187/3/E110.full
SO  - CMAJ2015 Feb 17; 187
AB  - Background: The seroprevalence of hepatitis C virus (HCV) infection among Canadians is estimated at 0.3% to 0.9%. Of those with chronic HCV infection, 10% to 20% will experience advanced liver disease by 30 years of infection. Targeted screening seems a plausible strategy. We aimed to estimate the health and economic effects of various screening and treatment strategies for chronic HCV infection in Canada.Methods: We used a state-transition model to examine the cost-effectiveness of 4 screening strategies: no screening; screen and treat with pegylated interferon plus ribavarin; screen and treat with pegylated interferon and ribavarin–based direct-acting antiviral agents; and screen and treat with interferon-free direct-acting antivirals. We considered Canadian residents in 2 age groups: 25–64 and 45–64 years of age. We obtained model data from the literature. We predicted deaths related to chronic HCV infection, costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios.Results: We found that screening and treating would prevent at least 9 HCV-related deaths per 10 000 persons screened over the lifetime of the cohort. Screening was associated with QALY increases of 0.0032 to 0.0095 and cost increases of $124 to $338 per person, which translated to an incremental cost-effectiveness ratio of $34 359 to $44 034 per QALY gained, relative to no screening, depending on age group screened and antiviral therapy received.Interpretation: A selective one-time HCV screening program for people 25–64 or 45–64 years of age in Canada would likely be cost-effective. Identification of silent cases of chronic HCV infection and the offer of treatment when appropriate could extend the lives of Canadians at reasonable cost.