OBJECTIVES: Our study aims to estimate the cost-effectiveness of universal HCV screening strategies in Poland. Hepatitis C virus (HCV) infection is characterised by slow disease progression, hidden symptoms and late diagnosis. Due to lack of HCV vaccination, limiting the burden of HCV infection requires efficient cases identification and treatment. Poland has relatively low prevalence of both anti-HCV antibodies and viraemic cases with up to 230 000 patients requiring treatment. Availability of rapid screening tests and new generation direct acting antivirals (DAA) allows for effective implementation of HCV screening programmes.

METHODS: A life-time Markov chain was built to investigate the effectiveness (life years gained, LYG; quality-adjusted life years, QALY) and cost of universal HCV screening programmes in Poland. Two economic models were combined: (1) a decision tree to model diagnostic process, and (2) a Markov chain to model disease progression and patients survival with/without universal screening. Six different scenarios of universal screening were tested (implementation of HCV testing to existing medical check-ups for secondary school, first job, driving licence, regular health check-ups at school (16-17 y.o. and 18-19 y.o.) and work (25-29 y.o., 30-39 y.o., 40-49 y.o.). Model parameters were based on the National Health Fund and published data. Deterministic and probabilistic sensitivity analyses were performed.

RESULTS: Screening existing employees (25-29 y.o., 30-39 y.o., 40-49 y.o.) and first job takers were the most cost-effective strategies resulting in dominant ICERs. Adding HCV screening to the driving licence health check-up resulted in the cost of one LYG or QALY below <150 EUR. Adding HCV screening to the secondary school health check-up was the least cost-effective strategy (50 000 LYG/EUR and 4 000 QALY/EUR).

CONCLUSIONS: Universal HCV screening would be highly cost-effective in Poland, especially in populations with obligatory or high pick-up of HCV screening. The strategies were complementary and using a combination would be most efficient.