Cost-Effectiveness Analysis of Screening for Persistent Hepatitis E Virus Infection in Solid Organ Transplant Patients in the United Kingdom: A Model-Based Economic Evaluation

Mar 1, 2020, 00:00
10.1016/j.jval.2019.09.2751
https://www.valueinhealthjournal.com/article/S1098-3015(19)35134-4/fulltext
Title : Cost-Effectiveness Analysis of Screening for Persistent Hepatitis E Virus Infection in Solid Organ Transplant Patients in the United Kingdom: A Model-Based Economic Evaluation
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(19)35134-4&doi=10.1016/j.jval.2019.09.2751
First page : 309
Section Title : ECONOMIC EVALUATION
Open access? : No
Section Order : 309

Background

Despite potentially severe and fatal outcomes, recent studies of solid organ transplant (SOT) recipients in Europe suggest that hepatitis E virus (HEV) infection is underdiagnosed, with a prevalence of active infection of up to 4.4%.

Objectives

To determine the cost-effectiveness of introducing routine screening for HEV infection in SOT recipients in the UK.

Methods

A Markov cohort model was developed to evaluate the cost-utility of 4 HEV screening options over the lifetime of 1000 SOT recipients. The current baseline of nonsystematic testing was compared with annual screening of all patients by polymerase chain reaction (PCR; strategy A) or HEV-antigen (HEV-Ag) detection (strategy B) and selective screening of patients who have a raised alanine aminotransferase (ALT) value by PCR (strategy C) or HEV-Ag (strategy D). The primary outcome was the incremental cost per quality-adjusted life-year (QALY). We adopted the National Health Service (NHS) perspective and discounted future costs and benefits at 3.5%.

Results

At a willingness-to-pay of £20 000/QALY gained, systematic screening of SOT patients by any method (strategy A-D) had a high probability (77.9%) of being cost-effective. Among screening strategies, strategy D is optimal and expected to be cost-saving to the NHS; if only PCR testing strategies are considered, then strategy C becomes cost-effective (£660/QALY). These findings were robust against a wide range of sensitivity and scenario analyses.

Conclusions

Our model showed that routine screening for HEV in SOT patients is very likely to be cost-effective in the UK, particularly in patients presenting with an abnormal alanine aminotransferase.

Categories :
  • Cost/Cost of Illness/Resource Use Studies
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Decision Modeling & Simulation
  • Economic Evaluation
  • Study Approaches
Tags :
  • cost-effectiveness
  • hepatitis E virus
  • screening
  • solid organ transplantation
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