Costs and cost-effectiveness of different follow-up schedules for detection of occupational hepatitis C virus infection

Deuffic-Burban, S.; Abiteboul, D.; Lot, F.; Branger, M.; Bouvet, E.; Yazdanpanah, Y.
January 2009
Gut;Jan2009, Vol. 58 Issue 1, p105
Academic Journal
Objective: The purpose of this study was to compare the costs and cost-effectiveness (C/E) of early hepatitis C virus (HCV) ANA testing (alternative-US recommendations) after occupational exposure to HCV with existing follow-up strategies: (1) French, anti-HCV antibodies and alanine transaminase (ALT) activity at months 1 3 and 6; (2) European, monthly ALT activity for 4 months and anti- HCV antibodies at month 6; (3) and baseline-US, anti-HCV antibodies and ALT activity at month 6. Methods: A decision tree simulated each strategy for 7300 healthcare workers (HCWs) exposed to HCV each year in France, taking into account the impact of early diagnosis on the response to antiviral treatment and the deterioration of HCW quality of life after exposure. Results: For a HCV transmission risk of 0.5% after exposure, the French strategy led to the highest costs! person (&3x20AC;181.40) and the baseline-US strategy to the lowest (&3x20AC;126.60) (&3x20AC;178501 for alternative-US). The shortest mean time to HCV infection diagnosis (1 month) and the lowest number of chronic hepatitis C (CHC) patients (1.9/7300 HCWs exposed) was obtained with the alternative-US strategy (vs 6 months and 7.9 CHC, respectively with baseline-US). Compared with the alternative-US, the French strategy was associated with higher costs and lower utilities, and the European with a higher incremental C/E ratio. Compared with the baseline- US strategy, the alternative-US strategy C/E ratio was &3x20AC;2020 per quality-adjusted life year saved. Conclusion: In HCWs exposed to HCV, a strategy based on early HCV RNA testing shortens the period during which the HCWs wait for his HCV status, leads to lower risk of progression to CHC and is reasonably cost- effective.


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