OBJECTIVES : In France, despite a large access to new effective HCV treatments, 43% of HCV infected patients remain unattainable because undiagnosed. We studied the epidemiological and economic impacts of five potential screening strategies in the French context.

METHODS : The screening strategy was modelled using a decision tree representing the key steps of screening including taking up screening, having a positive serology, having a positive confirmation RNA-test after a positive serology, initiating treatment and having a sustained virological response (SVR). The current situation was based on the currently observed screening rates (4.7% per year for the general population (GenPop), 96% at five years for People Who Inject Drugs (PWID) and 11% for immigrants), and treatment rates (95% for the GenPopGenPop, 72% for PWID, and 41% for immigrants). Alternative scenarios included an intensified screening program targetting PWID and immigrants, with a status quo for the GenPop, and several additional intensified screening modalities aimed at the GenPop depending on the age groups with the objective of screening 90% of the GenPop in five years, associated with an intensification for PWID and immigrants.

RESULTS : Intensified screening program for18-80 years subjects was the most effective strategy, avoiding 18,100 cirrhosis and 7,200 deaths, which leads to an Incremental Cost-Effectiveness Ratio (ICER) of 10,155 €/QALY.

CONCLUSIONS : GenPop screening programs seem to be the only options to significantly reduce the rate of undiagnosed HCV patients. These options can be cost-effective if they are integrated in the routine care with the implication of the general practitioners (GP).