Author: Manca F, Robinson E, Dillon JF, Boyd K

Theme: Epidemiology & Public Health Research Year: 2019

The World Health Organization target for HCV elimination by 2030 has broadened the boundaries of
the debate around HCV to strategic and economic considerations. Understanding how to prioritize
screening to reach infected undiagnosed populations is crucial. This is imperative in the UK, where
nearly half of the people infected are undiagnosed. This study evaluated the cost-effectiveness of a
range of strategies for diagnosing HCV across different populations using Scotland (UK) as case study.
Three key populations were identified: People who inject Drugs (PWID), high-risk patients among
general population (previous PWID, high prevalence ethnic minorities etc.) and prisoners. A costeffectiveness analysis was undertaken for each population comparing relevant alternative screening
strategies (e.g. testing at needle exchange services, pharmacies; prison opt out policies). Each
strategy, differing for point of care and targeted subpopulation, was compared against the standard
care diagnostic pathways from the Scottish NHS perspective. Data came from novel and standard care
pathways in Tayside (Scotland) or published pilot studies in Scotland. A decision tree explored the
incremental cost per additional positive patient detected, and a Markov model was employed to
present incremental cost per Quality Adjusted Life Years (QALYs) gained and Net Monetary Benefit
For the PWID, offering tests at Needle Exchange Services was the most effective strategy with a 6.3-
fold increase in detecting positive patients and the optimal strategy with a NMB of £188,837 over a
patient’s lifetime. Conversely, testing at GP services was the least cost-effective strategy, with a NMB
of £150,044 per patient. Similarly, for the other high risk populations, the most cost-effective
strategies consist of moving the point of care closer to the high risk individuals.
Access to testing is a significant obstacle for early diagnosis. Strategies that actively target high risk
subpopulations at early age of disease are highly cost-effective.
Disclosure of Interest Statement:
This work was supported by an Investigator Sponsored Research (ISR) project grant from Gilead
Sciences Inc. The design, conduct, and reporting of this study were undertaken by the academic
authors and do not reflect the opinions of the funder.

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