Valutazione economica di un programma di screening anti-HCV in Italia
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Economic evaluation of an anti-HCV screening program in Italy
The progression of hepatitis C (HCV) is usually developed over a ten-year-period. A high percentage of patients with chronic HCV contracts cirrhosis. The probability of developing liver cancer from chronic HCV over one year is 5%. These complications as well as the highly debilitating effects on patients, represent a significant item of expenditure for the National Health Service (NHS). Within the high risk population, the prevalence of the disease is 9–10% and is characterized, in the Italian scenario, by a high North-South gradient. Early detection of HCV is an excellent opportunity to improve patients’ QOL and to rationalize resource allocation, since the disease is characterized by a long preclinical phase, by the availability of treatments that can improve the prognosis and, moreover, by a high prevalence in the target population.
The aim of this study is to provide a cost-effectiveness evaluation of an anti-HCV screening program in the Italian NHS perspective.
We built a Markov model made up of two arms. The ‘Test Strategy’ arm involves a screening program based on the enzyme immunoassay for detection of antibodies (EIA) as first level test and the research of HCV virus RNA as second level positive patients are treated with Peg-interferon alpha 1a or Peg-interferon alpha 2b, both in combination with ribavirin. Parameters included in the model were derived from the literature and validated using experts’ opinions. Resource consumption was estimated in the Italian NHS perspective. Both costs and benefits were discounted at a 3.5% rate. Results were considered in terms of incremental cost per gained QALY by means of the screening program in comparison to no screening protocol. We performed a one-way and a multivariate sensitivity analysis to explore the effects of the key parameters variations on the model’s results.
The ‘Test Strategy’ ICER is €4,008.97/QALY. This value is acceptable, being lower than the threshold adopted by NICE. According to Montecarlo simulation results, the ICER remains below £40,000/QALY in 99% of scenarios.
The anti-HCV screening program represents a valid health-related investment for high risk populations, as it improves patients’ QOL and survival in view of an acceptable expenditure increase for NHS.
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