A COST-EFFECTIVENESS ANALYSIS OF HEPATITIS C SCREENING AMONG IMMIGRANTS IN CANADA.

Author(s)

Wendong Chen, MD, PhD student1, Katherine Dinner, MSc, Research Analyst2, Tom Wong, MD, Director2, Jenny Heathcote, MD, Senior Scientist and Head3, Murray D. Krahn, MD, MSc, FRCP(C), F. Norman Hughes Chair in Pharmacoeconomics31University of Toronto, Toronto, ON, Canada; 2 Public Health Agency of Canada, Ottawa, ON, Canada; 3 University Health Network, Toronto, ON, Canada

Objective: The costs and benefits of hepatitis C (HCV) screening among immigrants need to be assessed since about 20% of HCV cases in Canada are immigrants. Methods: A decision analytic model was developed to assess HCV screening among immigrants. The prevalence of hepatitis C and distributions of viral genotypes among immigrants were projected by the studies related to HCV epidemiology in their home countries. Meta-analyses of randomized trials were conducted to estimate the effectiveness of current anti-viral therapy (pegylated interferon plus ribavirin) in terms of genotype and disease stage. Survival regression model and logistic regression model were applied to project the transition probabilities for the disease progression by identifying cohort studies on the natural history of chronic HCV. The awareness of the disease, and the HCV incidence among immigrants were estimated using PHAC's surveillance data. The costs associated with HCV screening test, anti-viral therapy, and health care were estimated through published literatures. Cost-effectiveness analysis for immigrants was further stratified by world regions. Results: HCV screening was associated with an increase of life years (0.0013 years) and cost ($40.6) when compared to no screening for all immigrants ($30,552 per additional life year). HCV screening for immigrants born in South Asia was associated with longer life years (0.0108 years) and less cost (-$50.6). HCV screening strategy for immigrants born in Africa cost $8,635 to gain one additional life year. No obvious advantages of HCV screening were observed for immigrants from other areas. Conclusion: The preliminary findings suggest that it may be cost-effective to screen immigrants from South Asia and Africa. However, further studies are needed to confirm our findings.

Conference/Value in Health Info

2008-05, ISPOR 2008, Toronto, Ontario, Canada

Value in Health, Vol. 11, No. 3 (May/June 2008)

Code

CA3

Topic

Economic Evaluation

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis

Disease

Infectious Disease (non-vaccine)

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