Clin Mol Hepatol. 2022;28(1):91-104.

A cost-effectiveness study of universal screening for hepatitis C virus infection in South Korea: A societal perspective.

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제1저자 김혜린, 김경아 · 교신저자 정숙향

PMID 34736311 PMC8755471 DOI 10.3350/cmh.2021.0236 IF 21.7 소화기내과

소속 (4)

College of Pharmacy, Sahmyook University, Seoul, Korea.
Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.

Abstract

BACKGROUND/AIMS This study aimed to evaluate the cost-effectiveness of hepatitis C virus (HCV) screening compared to no screening in the Korean population from societal and healthcare system perspectives.

METHODS A published decision-tree plus Markov model was used to compare the expected costs and quality-adjusted life years (QALY) between one-time universal HCV screening and no screening in the population aged 40-65 years using the National Health Examination (NHE) program. Input parameters were obtained from analyses of the National Health Insurance claims data, Korean HCV cohort data, or from the literature review. The population aged 40-65 years was simulated in a model spanning a lifetime from both the healthcare system and societal perspectives, which included the cost of productivity loss due to HCV-related deaths. The incremental cost-effectiveness ratio (ICER) between universal screening and no screening was estimated.

RESULTS The HCV screening strategy had an ICER of $2,666/QALY and $431/QALY from the healthcare system and societal perspectives, respectively. Both ICERs were far less than the willingness-to-pay threshold of $25,000/QALY, showing that universal screening was highly cost-effective compared to no screening. In various sensitivity analyses, the most influential parameters on cost-effectiveness were the antibodies to HCV (anti-HCV) prevalence, screening costs, and treatment acceptance; however, all ICERs were consistently less than the threshold. If the anti-HCV prevalence was over 0.18%, screening could be cost-effective.

CONCLUSION One-time universal HCV screening in the Korean population aged 40-65 years using NHE program would be highly cost-effective from both healthcare system and societal perspectives.

Keywords

Cost effectivenessHepatitis C virusMass screeningsQuality adjusted life years

Figures

**Figure 1.** Cost-effectiveness model including (A) decision tree model and (B) Markov model. The model has two parts: (A) decision tree model and (B) Markov model. (A) Populations were divided into subgroups according to screening, diagnosis, and treatment. (B) Populations were entered into the Markov model and moved to 28 predefined health states, including chronic hepatitis (F stage 0–3), compensated LC (F4), decompensated cirrhosis (DC), HCC, SVR, and liver transplantation, and death by each transition probability. The cycle length of the Markov model was 1 year, and the lifetime horizon was chosen. In each cycle, patients either remained in their current health state (recursive arrow) or progressed to another health state (straight arrow) according to the transition probability. HCV, hepatitis C virus; Tx, treatment; SVR, sustained virologic response; LC, liver cirrhosis.

**Figure 2.** One-way sensitivity analysis presented through a tornado diagram. The most influential parameter on the ICERs was anti-HCV prevalence, showing that the ICER decreased remarkably as the prevalence of anti-HCV increased. This was followed by the screening cost according to the different immunoassay tests. Other variables affecting the ICERs included the detection rate without HCV screening, discount rate, acceptance rate of DAA treatment, utility weight for SVR, cohort age, SVR rate of DAA agent, utility weight for F0–F3, medical costs for HCC and DC, and HCV genotype testing. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life years; HCV, hepatitis C virus; DAA, direct acting antiviral; Tx, treatment; SVR, sustained virologic response; HCC, hepatocellular carcinoma; DC, decompensated cirrhosis.

**Figure 3.** Changes in ICERs according to anti-HCV prevalence. The changes in ICER according to various anti-HCV prevalence are shown. From a healthcare system perspective, the ICER was $15,170/QALY with 0.2% anti-HCV prevalence and $527/QALY with 2.0% of it. Similarly, in the analysis from a societal perspective, the trend of ICER changed according to anti-HCV prevalence. With the anti-HCV prevalence over 0.179–0.186%, universal screening is cost-effective (ICER <$25,000/QALY) from both healthcare system and societal perspectives. ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life years; anti-HCV, antibodies to hepatitis C virus.

**Figure 4.** Cost-effectiveness acceptability curve. The results of the probabilistic sensitivity analysis simulated 10,000 times are illustrated. This indicates that the probability of a one-time screening and DAA therapy being cost-effective is 60.3%, 81.8%, and 97.7% with a WTP of $1,000, $2,000, and $5,000, respectively. QALY, quality-adjusted life years; DAA, direct acting antiviral; WTP, willingness-to-pay.

그림 출처: PubMed Central 공개 논문 (PMC8755471)

Conflict of interest statement

Conflicts of Interest . SH Jeong has served as an advisor for Gilead. The remaining authors disclose no conflicts.

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