1786. The cost-effectiveness of hepatitis C screening strategies among adolescents and young adults in primary care settings
Session: Oral Abstract Session: HCV Advances
Saturday, October 29, 2016: 10:43 AM
Room: 388-390

Background: High hepatitis C virus (HCV) case rates have been reported in young people who inject drugs (PWID). The current Centers for Disease Control and Prevention (CDC) guidelines recommend risk-based HCV screening for this group. We evaluated the clinical benefit and cost-effectiveness of screening strategies among youth seen in community health centers in neighborhoods with a high number of reported HCV cases.

Methods: We developed a decision analytic model to project quality-adjusted life years (QALYs), lifetime costs (2014 US $), and incremental cost-effectiveness ratios (ICER) associated with nine screening strategies among 15- to 30-year-olds. The strategies differed in three ways: 1. Rapid fingerstick vs. venipuncture diagnostics; 2. Ordered by physician vs. counselor/tester using standing orders; 3.Targeted vs. universal testing. All rapid testing results were available during the visit. We performed deterministic and probabilistic sensitivity analyses (PSA) to evaluate model uncertainty. Outcomes were discounted at 3% annually.

Results: Compared to risk-based testing (current standard of care), universal screening increased lifetime medical cost by $50 and discounted QALYs by 0.0031. Across all nine strategies rapid testing provided higher QALYs at a lower cost per QALY gained, and it was always the preferred approach. Targeted rapid screening performed by a counselor expanded QALYs by 0.001 and was associated with $13,200/QALY gained. In comparison, counselor-performed universal rapid testing provided greater QALYs with a cost of $24,600/QALY gained. In univariate sensitivity analyses, counselor-performed universal rapid testing was the optimal strategy unless the prevalence of PWID was < 0.16%, the HCV prevalence was < 5% among young PWID, or the lifetime re-infection rate was > 95% (assuming potential for one-time re-treatment). In PSA, universal rapid testing was the optimal strategy in 99% of simulations at a willingness-to-pay threshold of $100,000/QALY.

Conclusion: Our results suggest that one-time universal HCV screening among 15- to 30-year-olds using rapid testing may be a cost-effective strategy to address HCV in neighborhoods with a high number reported HCV cases.

Sabrina Assoumou, MD, MPH1, Abriana Tasillo, BA2, Jared a. Leff, MS3, Bruce R. Shackman, PhD4, Mari-Lynn Drainoni, MEd, PhD5,6,7, C. Robert Horsburgh, MD MUS8, Anita Barry, MD, MPH9, Craig Regis, MPH9, Arthur Kim, MD, FIDSA10,11, Alison Marshall, RN, MSN, FNP-C12, Sheel Saxena, MD13 and Benjamin Linas, MD, MPH14, (1)Internal Medicine, Boston University School of Medicine, Boston, MA, (2)HIV Epidemiology & Outcomes Unit, Section of Infectious Diseases, Boston Medical Center, Boston, MA, (3)Weill Cornell Medical College, New York, NY, (4)Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, NY, (5)Boston University School of Medicine, Boston, MA, (6)Boston University School of Public Health, Boston, MA, (7)Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, (8)Department of Epidemiology, Boston University School of Public Health, Boston, MA, (9)Infectious Diseases Bureau, Boston Public Health Commission, Boston, MA, (10)Medicine, Harvard Medical School, Boston, MA, (11)Infectious Diseases, Massachusetts General Hospital, Boston, MA, (12)Boston College Connell School of Nursing, Chestnut Hill, MA, (13)South Boston Community Health Center, Boston, MA, (14)Internal Medicine, Section of Infectious Disease, Boston Medical Center, Boston University School of Medicine, Boston, MA

Disclosures:

S. Assoumou, None

A. Tasillo, None

J. A. Leff, None

B. R. Shackman, None

M. L. Drainoni, None

C. R. Horsburgh, None

A. Barry, None

C. Regis, None

A. Kim, None

A. Marshall, None

S. Saxena, None

B. Linas, None

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