Cost effectiveness of screening for hepatitis C virus in asymptomatic, average-risk adults.

PURPOSE To estimate the cost effectiveness of screening for hepatitis C in asymptomatic, average-risk adults. METHODS We used a Markov decision analysis model to estimate the lifetime cost effectiveness of three screening strategies: (1) initial screening for hepatitis C antibody by third-generation enzyme-linked immunosorbent assay (ELISA), followed by confirmatory testing for hepatitis C virus ribonucleic acid (RNA) using polymerase chain reaction (PCR); (2) initial screening for hepatitis C virus RNA by PCR only; and (3) the current practice of not screening. The patient population comprised a hypothetical cohort of average-risk adults presenting to their regular primary health care provider for routine physical examination. The main outcome measure was cost per additional quality-adjusted life-year (QALY) gained. RESULTS The no screening strategy was the dominant strategy in the baseline analysis. The model was most sensitive to the reduction in quality of life related to patient awareness of hepatitis C infection. Screening with ELISA and PCR was preferred when this value was <0.01 and was cost effective if more than half of the patients who tested positive for hepatitis C actually initiated treatment, or if the annual rate of progression to cirrhosis was greater than 2.5%. Screening with PCR only was never cost effective. CONCLUSIONS This analysis does not support the widespread screening for hepatitis C among asymptomatic, average-risk adults.