Journal of Public Health 26(1) © Faculty of Public Health 2004; all rights reserved.
Screening for Hepatitis C in injecting drug users: a cost utility analysis
Ken Stein, Senior Lecturer in Public Health1
Kim Dalziel, Research Fellow1
Andrew Walker, Health Economist2
Becky Jenkins, Public Health Specialist3
Alison Round, Senior Lecturer in Public Health1
Pam Royle, Research Fellow4
1 Peninsula Technology Assessment Group, Peninsula Medical School, Universities of Exeter and Plymouth, Dean Clarke House, Southernhay East, Exeter EX1 1PQ
2 Robertson Centre for Biostatistics, Boyd-Orr Building, University of Glasgow, University Avenue, Glasgow G12 8QQ
3 North & East Devon Health Authority, Dean Clarke House, Southernhay East, Exeter EX1 1PQ
4 Southampton Health Technology Assessment Centre, Mailpoint 728, Boldrewood, University of Southampton, Highfield, Southampton SO16 7PX
Address correspondence to Dr Ken Stein. E-mail: ken.stein{at}pms.ac.uk
Background Hepatitis C is a major public health problem of increasing importance among injecting drug users, among whom screening has been proposed. We therefore estimated the cost utility of screening for hepatitis C infection among people with a history of injecting drug use in contact with drug misuse services.
Methods A spreadsheet-based model of screening using ELISA followed by polymerase chain reaction tests and treatment using combination therapy with interferon alpha and ribavirin was developed. Parameters were informed by literature review, expert opinion and a survey of current screening practice in England. A range of one-way sensitivity analyses were carried out to explore uncertainty in the results for cost effectiveness.
Results Screening for HCV is likely to yield benefits in the population concerned at around £28000 per quality adjusted life year. This estimate is reasonably stable when explored in extensive one-way sensitivity analysis but appeared sensitive to the proportion of HCV positive people who accept biopsy or treatment and the utility gains associated with successful drug treatment. Important other areas of uncertainty include the effects of mortality from other causes on the cost effectiveness of screening in this population and the time at which symptoms would have led to presentation in the absence of a screening programme.
Conclusion Screening for HCV in this population is moderately cost effective, although some caution must remain in accepting this estimate given the current uncertainties in this field, and further research is required.
Keywords: screening, hepatitis C, drug users, cost utility