OBJECTIVES:

Hepatitis C virus (HCV) is a common infection that causes costly liver and extrahepatic complications. Direct-acting antivirals (DAAs) offer >95% cure rates. Patients at high-risk for HCV infection who presented to the emergency department (ED) at UI Health received HCV screening and linkage to DAA treatment. However, HCV screening in the ED is currently not covered by insurance providers. The aim of this study was to assess the long-term cost-effectiveness of routine HCV screening and linkage to care for high-risk patients in the emergency department from the payer’s perspective.

METHODS:

A hybrid decision-analytic and Markov model was developed to estimate cost-effectiveness of HCV screening in the ED and linkage to care versus usual ED care (i.e., no HCV screening). A one-year cycle length and 30-year time horizon were used. Patients who were not screened and treated eventually developed complications and received treatment at later stages of HCV. In the base-case, untreated patients were treated when decompensated cirrhosis developed. A scenario analysis evaluated the impact of untreated patients being treated when compensated cirrhosis developed. Transition probabilities, healthcare costs, and utilities were derived from the ED screening program or published literature. DAA costs were obtained from Redbook. A 3% discount rate was applied to costs and utilities. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted to assess uncertainty.

RESULTS:

For the base-case, total healthcare costs of HCV screening and no HCV screening were $155,259 and $155,208 and QALYs were 11.48 and 11.47, respectively, with an incremental cost-effectiveness ratio (ICER) of $5,140 per QALY gained. When untreated patients were treated upon developing compensated cirrhosis, the ICER became $6,816.19. Results were stable in sensitivity analyses.

CONCLUSIONS:

ED-based HCV screening and linkage to care reduces morbidity and mortality and is extremely cost-effective. A reduction in infected persons in the community may provide additional benefits not evaluated here.