The impact of the size of the tested population, the numbers eligible for treatment, disease
stage, and the prioritization and timing of treatment on overall cost-effectiveness is not well understood. Therefore, the principal objective of this study was to estimate the relationship between the cost-effectiveness of a one-time birth cohort testing of the population born between 1945 and 1965 and a risk-based testing of the same population to identify whether a phased time-dependent, age-dependent, and fibrosis stage–dependent treatment program offers value from a health economics perspective. We omitted anyone born outside Crenolanib cost of the birth cohort population from the analysis, because they were assumed to be tested within the risk-based strategy and thus would be unaffected by the birth cohort program. A secondary
objective was to understand how the timing of treatment initiation impacts costs, QALYs and HCV-related complications avoided. An estimation of the natural history of DMXAA progression from chronic infection to ESLD was conducted using the MONARCH (MOdelling the NAtural histoRy and Cost effectiveness of Hepatitis C) model. This is a cohort-based Markov lifetime simulation that has been described in detail.21 Additionally, we utilized a testing and treatment decision tree in combination with the MONARCH model to assess the lifetime costs, life years, and QALYs associated MCE公司 with
number of testing and treatment-related scenarios. We modeled a population comprising all individuals born between 1945 and 1965 in the United States (66.9 million people). From this population, we excluded those previously diagnosed with chronic HCV (∼674,480 people).16 Our analysis compared two testing strategies. First, a risk-based strategy in which those at-risk in the population (persons with a history of injection drug use, recipients of blood clotting factor concentrates produced prior to 1978, blood transfusion or organ transplantation prior to 1992, long-term dialysis, children from HCV-infected mothers and those in occupations that expose them to HCV)15 are tested. The risk-based strategy tests approximately 22.34% (14,793,816 members) of the total population and identifies 1.77% (262,260 people) with chronic HCV.17 Second, the birth cohort testing strategy outlined above is implemented assuming 91.21% (60,404,514 members) of the total population are tested, identifying approximately 1.77% (1,070,840 people) with chronic HCV. In both scenarios, we compare the costs and effects of a one-time testing and treatment program. A flow diagram of the two scenarios is shown in Fig. 1.