OBJECTIVES : The hepatitis C virus (HCV) is a blood-borne virus which may not become symptomatic until decades following exposure. Focus has shifted towards identifying currently undiagnosed patients with chronic HCV since the introduction of direct-acting antiviral (DAA) treatment (in 2011) which is curative and acceptable to patients. We undertook a systematic review of the international cost-effectiveness evidence of birth cohort screening for HCV in an asymptomatic population to understand why cost-effectiveness may vary and what implications this has for countries considering its introduction.

METHODS : Economic evaluations comparing birth cohort screening with no screening or risk-based screening, where patients were treated with DAAs, were eligible for inclusion. Embase, Medline and grey literature sources were searched up to February 2019. Screening, data extraction, quality and transferability assessment were conducted in duplicate. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The proposed methodology was registered on PROSPERO (CRD42019127159). Costs are presented in 2018 Euro.

RESULTS : Thirteen studies were included. Study quality and transferability were variable, ranging from low to high. The estimated incremental cost-effectiveness ratios (ICERs) ranged from €7,574 to €105,121 per QALY gained. One study found that birth cohort screening dominated no screening. The uncertainty surrounding the cost-effectiveness of screening was mainly influenced by the uptake rates of screening and treatment, liver fibrosis score at diagnosis and prevalence of chronic HCV infection. No study modelled a systematic population-based screening programme (associated with higher uptake).

CONCLUSIONS : The ICERs estimated by international studies varied considerably due mainly to differences in input parameters (prevalence, treatment costs, treatment effectiveness and treatment criteria). Of the 13 studies included, eight would be considered cost-effective at a willingness-to-pay threshold of €45,000/QALY. Given the variation in results and potential cost of implementing birth cohort screening, jurisdiction-specific economic evaluations will generally be required to inform policy decision-making.