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Publication - Professor Matthew Hickman

    The cost-effectiveness of one-time birth cohort screening for hepatitis C as part of the NHS health check programme in England

    Citation

    Williams, J, Miners, A, Harris, RJ, Mendal, S, Simmons, R, Ireland, G, Hickman, M, Gore, C & Vickerman, P, 2019, ‘The cost-effectiveness of one-time birth cohort screening for hepatitis C as part of the NHS health check programme in England’. Value in Health.

    Abstract

    Objectives
    We aim to evaluate the cost-effectiveness of one-time HCV screening for individuals born between 1950 and 1979 as part of the NHS health check in England, a health check for adults aged 40-74 years old in primary care.

    Methods
    A Markov model was developed to analyse add-on HCV testing to the NHS health check for individuals in birth cohorts between 1950 and 1979, versus current background HCV testing only, over a lifetime time horizon. The model used data from a back-calculation model of the burden of HCV in England, sentinel surveillance of HCV testing, and published literature. Results are presented from a health service perspective in pounds (GBP) in 2017, as incremental cost-effectiveness ratios (ICERs) per quality adjusted life years (QALY) gained.

    Results
    Base case ICERs ranged from £7,648 to £24,434, and £18,681 to £46,024, across birth cohorts when considering two sources of HCV transition probabilities. The intervention is
    most likely to be cost-effective for those born in the 1970’s, and potentially cost-effective for those born from 1955-1969. The model results were most sensitive to the source of HCV transition probabilities, the probability of referral and receiving treatment, and the HCV prevalence amongst testers. The maximum value of future research across all birth cohorts was £11.3 million at £20,000 per QALY gained.

    Conclusions
    Birth cohort screening is likely to be cost-effective for younger birth cohorts, although considerable uncertainty exists for other birth cohorts. Further studies are warranted to reduce uncertainty in cost-effectiveness and consider the acceptability of the intervention.

    Full details in the University publications repository