PharmacoEconomics & Outcomes News | 2021
Reflex HCV RNA or antigen testing cost effective for HCV screening
Abstract
Reflex hepatitis C virus (HCV) RNA or HCV antigen (HCV-AG) testing appear to be the most cost-effective HCV screening strategies in Italy, according to findings of a study presented at the International Liver Congress 2021. A Markov model was used to evaluate the cost effectiveness of various screening strategies for detecting active HCV in a birth cohort from 1969 to 1989, including detection of HVC antibodies (HCV-Ab) by rapid or phlebotomy-based assays, followed by confirmatory HCV-RNA or HCV-AG testing on visit 2 or by Reflex HCV-RNA or HCV-AG testing during visit 1. Cost effectiveness was assessed from an Italian healthcare system perspective over a 20-year time horizon, with the screening algorithm that produced the lowest QALY gain used as the reference option. Rapid HCV-Ab testing plus HCV-AG was estimated to achieve the lowest QALY gain, whilst Reflex HCV-RNA testing followed by Reflex HCV-AG testing achieved the highest QALY gain. Reflex HCV-RNA testing was the most cost-effective strategy compared with Rapid HCV-Ab testing plus HCV-AG, with an estimated incremental cost-effectiveness ratio (ICER) of €873 per QALY gained, which was well below the willingness-to-pay threshold of €25 000 per QALY gained. Single-visit Reflex testing was more cost-effective than twovisit strategies, with higher QALY gains and very low ICERs. Probabilistic sensitivity analysis found that both Reflex HCV-RNA and Reflex HCV-AG testing were highly cost effective. Reflex testing using either HCV RNA or HCV-AG is the most cost effective and sustainable with the dedicated screening fund in Italy, concluded the authors. These findings support the European Association for the Study of the Liver (EASL) clinical practice guidelines recommending Reflex testing as the most cost-effectiveness screening pathway, they said.