OBJECTIVES

We aimed to assess the cost-effectiveness of hepatitis C virus (HCV) screening and treatment strategies among recently arrived migrants for the Netherlands.

METHODS

The health effects and costs of HCV screening and treatment were estimated from the healthcare perspective using a Markov model. Two cohorts of migrants were defined: migrants from non-Western countries (50,000) and migrants from HCV-endemic countries (25,000). In these cohorts, three HCV screening and treatment strategies were evaluated: (i) no screening; (ii) monitoring, in which migrants are screened for HCV and HCV-positive individuals without liver fibrosis (F0) are subsequently monitored and patients with liver fibrosis or cirrhosis (F1-F4) are treated; and (iii) early treatment, in which, after screening, all HCV-positive individuals (F0-F4) are treated.

RESULTS

In the cohort of migrants from non-Western countries, monitoring strategy compared to no screening, would yield 2,789 quality-adjusted life years (QALYs) at a cost of € 4,387,849 and an incremental cost-effectiveness ratio (ICER) of € 1,699 per QALY gained. The early treatment strategy compared to the monitoring strategy would yield no health gains at a cost of € 27,369,482. In the cohort of migrants from HCV-endemic countries, monitoring strategy compared to no screening, would yield 1,860 QALYs at a cost of € 3,053,189 and an ICER of € 1,642 per QALY gained. The early treatment strategy compared to the monitoring strategy would yield no health gains at a cost of € 18,246,321. The budget impacts of the monitoring strategy among migrants from non-Western countries and migrants from HCV-endemic countries were €5,022,095 and € 3,242,313, respectively.

CONCLUSIONS

Screening for HCV with just monitoring of HCV-positive patients without liver fibrosis and treatment of patients with liver fibrosis or cirrhosis is cost-effective. With similar ICERs in both cohorts of migrants, the budget impact may have a strong influence on decision making. The early treatment strategy was not cost-effective.