Optimization of hepatitis C virus screening strategies by birth cohort in Italy

BACKGROUND AND AIMS: Cost‐effective screening strategies are needed to make hepatitis C virus (HCV) elimination a reality. We determined if birth cohort screening is cost‐effective in Italy. METHODS: A model was developed to quantify screening and healthcare costs associated with HCV. The model‐estimated prevalence of undiagnosed HCV was used to calculate the antibody screens needed annually, with a €25 000 cost‐effectiveness threshold. Outcomes were assessed under the status quo and a scenario that met the World Health Organization's targets for elimination of HCV. The elimination scenario was assessed under five screening strategies. RESULTS: A graduated birth cohort screening strategy (graduated screening 1: 1968‐1987 birth cohorts, then expanding to 1948‐1967 cohorts) was the least costly. This strategy would gain approximately 144 000 quality‐adjusted life years (QALYs) by 2031 and result in an 89.3% reduction in HCV cases, compared to an 89.6%, 89.0%, 89.7% and 88.7% reduction for inversed graduated screening, 1948‐77 birth cohort, 1958‐77 birth cohort and universal screening, respectively. Graduated screening 1 yielded the lowest incremental cost‐effectiveness ratio (ICER) of €3552 per QALY gained. CONCLUSIONS: In Italy, a graduated screening scenario is the most cost‐effective strategy. Other countries could consider a similar birth cohort approach when developing HCV screening strategies.