Skip to main content

Valutazione economica di un programma di screening anti-HCV in Italia

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.

This is a preview of subscription content, access via your institution.


  1. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatitis C virus infection. J Hepatol 2011; 55: 245–64

    Article  Google Scholar 

  2. Sroczynski G, Esteban E, Conrads-Frank A, et al. Long-term effectiveness and cost-effectiveness of screening for hepatitis C virus infection. Eur J Public Health 2009; 19: 245–53

    PubMed  Article  Google Scholar 

  3. Sonnenberg FA, Beck JR. Markov models in medical decision making: a practical guide. Med Decis Making 1993; 13: 322–38

    PubMed  Article  CAS  Google Scholar 

  4. Alagoz O, Hsu H, Schaefer AJ, et al. Markov decision processes: a tool for sequential decision making under uncertainty. Med Decis Making 2010; 30: 474–83

    PubMed  Article  Google Scholar 

  5. ISTAT. Tavole di mortalità per sesso ed eta anno 1993. Roma: ISTAT

    Google Scholar 

  6. Sullivan SD, Craxì A, Alberti A, et al. Rapporto costo efficacia della terapia peginterferone alfa−2a+ribavirina in confronto a interferone alfa−2b+ribavirina in pazienti affetti da epatite cronica di tipo C precedentemente non trattati. PharmacoEconomics-Italian Research Articles 2004; 6: 105–14

    Google Scholar 

  7. Nakamura J, Toyabe SI, Aoyagi Y, et al. Economic impact of extended treatment with peginterferon alpha−2a and ribavirin for slow hepatitis C virologic responders. J Viral Hepat 2008; 15: 293–9

    PubMed  Article  CAS  Google Scholar 

  8. Associazione Italiana per lo Studio del Fegato (AISF). Profilassi e terapia dell’epatite B nei pazienti immuno-compromessi. Torino, 2005

  9. Stroffolini T, Rapicetta M, Di Stefano R. Hepatitis C virus clearance and gender. Gut 2007; 56: 884

    PubMed  Article  CAS  Google Scholar 

  10. Ansaldi F, Bruzzone B, Salmaso S, et al. Different seroprevalence and molecular epidemiology patterns of hepatitis C virus infection in Italy. J Med Virol 2005; 76: 327–32

    PubMed  Article  CAS  Google Scholar 

  11. Pawlotsky JM. Use and interpretation of virological tests for hepatitis C. Hepatology 2002; 36 (5 Suppl. 1): S65–73

    PubMed  Article  Google Scholar 

  12. Stroffolini T. Epidemiologia di HCV in Italia: situazione presente e futura. Slide kit. Roma, 26 novembre 2010. (accesso giugno 2011)

    Google Scholar 

  13. Agenzia Italiana del Farmaco:

  14. “Ricognizione e primo aggiornamento delle tariffe massime per la remunerazione delle prestazioni sanitarie”. Gazzetta Ufficiale n. 289 del 13 dicembre 2006

  15. Ministero della Salute. Programmazione Sanitaria e Qualita leggi e documenti-Tariffario in euro delle prestazioni specialistiche, delle protesi e DRG. (accesso giugno 2011)

  16. Chapman RH, Stone PW, Sanberg EA, et al. A comprehensive league table of cost utility ratios and a sub-table of “panel worthy” studies. Med Decis Making 2000; 20: 451–67

    PubMed  Article  CAS  Google Scholar 

  17. Lucioni C, Ravasio R. Come valutare i risultati di uno studio farmacoeconomico? PharmacoEconomics-Italian Research Articles 2004; 6: 121–30

    Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to M. Ruggeri.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cicchetti, A., Ruggeri, M., Coretti, S. et al. Valutazione economica di un programma di screening anti-HCV in Italia. Pharmacoeconomics-Ital-Res-Articles 13, 81–99 (2011).

Download citation

  • Published:

  • Issue Date:

  • DOI: