Hepatitis C virus (HCV) screening for injection drug users in the United States may be a cost-effective intervention to combat HCV infections and could potentially decrease the risk of untreated HCV infection and liver-related mortality, according to data from a simulated economic evaluation published in JAMA Network Open.

Investigators used a decision-analytic Markov model of the natural history and progression of HCV to evaluate the cost-effectiveness of HCV screening programs. They compared screening programs that target people who inject drugs (PWID) with universal screening of US adults aged 18 years and older. The outcomes were measured in quality-adjusted-life-years (QALY).

Results of a 10,000 Monte Carlo microsimulation trial comparing a baseline of men and women aged 40 years and PWID drugs in the United States revealed that screening and treatment for HCV were estimated to increase total costs by $10,457 per person and increase QALYs by 0.23, or approximately 3 months. This would lead to an incremental cost-effectiveness ratio of $45,465 per QALY. Universal screening and treatment were estimated to increase total costs by $2845 per person and increase QALYs by 0.01, resulting in an incremental cost-effectiveness ratio of $291,277 per QALY.

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The Markov model assumed potential HCV reinfection to be one percent, which is the probability of reinfection among the general population; for PWID, the reinfection rate is eleven percent. The model only included direct medical costs, as indirect costs related to HCV treatment may be significant. Wholesale acquisition costs, which are frequently used in economic analysis because they are reasonably transparent and consistent, were used to calculate costs. Direct cost estimates were obtained from published sources and may not fully reflect actual costs of treatment for particular regions or medical systems in the United States. Finally, the model did not account for individuals failing to complete treatment and assumes diagnosed individuals complete the 8-week drug treatment regimen. Therefore, “to the extent that individuals fail to complete the regimen, our analysis may overstate the cost-effectiveness of screening.”

According to investigators, infection rates among PWID drugs are between thirty to ninety percent.  If untreated, “HCV infection may progress to liver cirrhosis and, ultimately, death.” There are new drug protocols to treat HCV. Based on the results of the simulations, if using an incremental cost-effectiveness ratio of $50,000 per QALY as a cut-off, HCV screening tailored to injection drug users is cost-effective in avoiding premature deaths and liver transplantations.

Disclosure: A study author has declared affiliations with a pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Tatar M, Keeshin SW, Mailliard M, et al. Cost-effectiveness of universal and targeted hepatitis C virus screening in the United States. JAMA Netw Open. 2020;3(9):e2015756.