Cost-effective screening for acute hepatitis C virus infection in HIV-infected men who have sex with men.
Open accessAbstract
BACKGROUND: We used a Monte Carlo computer simulation to estimate the effectiveness and cost-effectiveness of screening for acute hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected men who have sex with men. METHODS: One-time screening for prevalent HCV infection was performed at the time of enrollment in care, followed by either symptom-based screening, screening with liver function tests (LFTs), HCV antibody (Ab) screening, or HCV RNA screening in various combinations and intervals. We considered both treatment with pegylated interferon and ribavirin (PEG/RBV) alone and with an HCV protease inhibitor. Outcome measures were life expectancy, quality-adjusted life expectancy, direct medical costs, and cost-effectiveness, assuming a societal willingness to pay $100000 per quality-adjusted life-year (QALY) gained. RESULTS: All strategies increased life expectancy (from 0.49 to 0.94 life-months), quality-adjusted life expectancy (from 0.47 to 1.00 quality-adjusted life-months), and costs (from $1900 to $7600), compared with symptom-based screening. The incremental cost-effectiveness ratio of screening with 6-month LFTs and a 12-month HCV Ab test, compared with symptom-based screening, was $43 700/QALY (for PEG/RBV alone) and $57 800/QALY (for PEG/RBV plus HCV protease inhibitor). The incremental cost-effectiveness ratio of screening with 3-month LFTs, compared with 6-month LFTs plus a 12-month HCV Ab test, was $129 700/QALY (for PEG/RBV alone) and $229 900/QALY (for PEG/RBV plus HCV protease inhibitor). With HCV protease inhibitor-based therapy, screening with 6-month LFTs and a 12-month HCV Ab test was the optimal strategy when the HCV infection incidence was ≤1.25 cases/100 person-years. The 3-month LFT strategy was optimal when the incidence was >1.25 cases/100 person-years. CONCLUSIONS: Screening for acute HCV infection in HIV-infected MSM prolongs life expectancy and is cost-effective. Depending on incidence, regular screening with LFTs, with or without an HCV Ab test, is the optimal strategy.
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Screening for HCV in this setting is cost-effective.
“Screening for HCV in this setting is cost-effective (238,239).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [238]
Regular screening of persons with HIV for HCV is cost-effective.
“Because acute HCV infection acquisition among persons with HIV infection can occur, especially among MSM, and regular screening of those with HIV is cost-effective (238,239,1377), periodic HCV screening should be conducted (1378–1380).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [238]
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- Authors
- Linas, B. P., Wong, A. Y., Schackman, B. R., Kim, A. Y., & Freedberg, K. A.
- Affiliations
- Boston University (US)
- Weill Cornell Medicine (US)
- Harvard University (US)
- Corresponding author
- Linas, Benjamin P.
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-04-04
- Volume
- 55
- Issue
- 2
- Pages
- 279-290
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- PMC
- PMC3403839
- OpenAlex
- W2147821290
- Cited by
- 61
- References
- 67
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 3 · 2021: 7 · 2020: 2 · 2019: 5 · 2018: 4 · 2017: 1 · 2016: 8 · 2015: 9 · 2014: 7 · 2013: 6 · 2012: 3
- FWCI
- 5.01
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Clinical Infectious Diseases (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (R01DA027379)
- National Institute of Allergy and Infectious Diseases (K24AI062476, R37AI042006, U19AI066345, K01AI073193, P30AI060354)
- Topics
- Health Sciences › Medicine › Hepatology › Hepatitis C virus research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Surgery › Helicobacter pylori-related gastroenterology studies
- Keywords
- HIV infection, men who have sex with men, HCV screening, cost-effectiveness, liver function tests, HCV antibody testing, HCV RNA testing, pegylated interferon and ribavirin, HCV protease inhibitors, quality-adjusted life expectancy, HCV incidence, symptom-based screening, Monte Carlo simulation, HIV/HCV coinfection
- MeSH terms
- Adult, Antiviral Agents, Cost-Benefit Analysis, Hepatitis C, Humans, Immunoassay, Interferons, Life Expectancy, Liver Function Tests, Male, Mass Screening, Middle Aged, Protease Inhibitors, Ribavirin, HIV Infections, Health Care Costs, Homosexuality, Male, Hepatitis C Antibodies
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