Optimization of hepatitis C virus screening strategies by birth cohort in Italy

Background and Aims: Cost-effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost-effective in Italy. Methods: A model was developed to quantify costs associated with HCV, denominated in quality-adjusted life years (QALYs). The model-estimated prevalence of undiagnosed HCV was used to calculate the antibody screens needed annually, with a €25,000 cost-effectiveness threshold. Outcomes were assessed under the status quo and a scenario that met the World Health Organization's targets for elimination of HCV. The elimination scenario was assessed under five screening strategies. Results: A graduated birth cohort strategy (screening 1: 1968-1987 birth cohorts then expanding to 1948-1967 cohorts) was the least costly. This strategy would gain 143,929 QALYs by 2031 and result in an 89.3% reduction in HCV cases, compared to an 89.6%, 89.0%, 89.7%, and 88.7% reduction for inversed graduated screening, 1948-77 birth cohort, 1958-77 birth cohort, and universal screening, respectively. Graduated screening 1 yielded the lowest incremental cost-effectiveness ratio (ICER) of €3,552 per QALY gained. Conclusions: In Italy, a graduated screening scenario is the most cost-effective strategy. Other countries could consider a similar birth-cohort approach when developing screening strategies.