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Family Practice Advance Access published online on June 23, 2006
Family Practice, doi:10.1093/fampra/cml032
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© The Author (2006). Published by Oxford University Press. All rights reserved.
Received January 9, 2006
Accepted May 23, 2006

Article

Case finding for hepatitis C in primary care: a cost utility analysis

Joanna Thompson Coon 1 *, Emanuela Castelnuovo 1, Martin Pitt 1, Matthew Cramp 2, Uwe Siebert 3, and Ken Stein 1

1 Peninsula Technology Assessment Group (PenTAG), Peninsula Medical School, Universities of Plymouth and Exeter, Noy Scott House, Barrack Road, Exeter, EX2 5DW, UK
2 Hepatology Department, Derriford Hospital, and Peninsula Medical School, Plymouth, UK
3 Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Public Health, Medical Decision Making and HTA, University of Health Sciences, Medical Informatics and Technology, Hall i.T, Austria

* To whom correspondence should be addressed.
Joanna Thompson Coon, E-mail: Joanna.Thompson-Coon{at}pentag.nhs.uk.


  Abstract

Background. Hepatitis C is an important public health problem. The need for more intensified action to identify those infected with the virus has been recognized. Primary care is an important setting for case finding.

Objectives. To estimate the cost utility of case finding for hepatitis C in primary care, specifically amongst former injecting drug users (IDUs).

Methods. A Markov model was developed to investigate the impact of case finding and treatment on progression of hepatitis C (HCV) in a hypothetical cohort of 1000 former IDUs. Comparison was made with a similar cohort in which no systematic case finding was implemented but spontaneous presentation for testing was allowed. Two scenarios were explored. The testing protocol utilized ELISA and PCR tests. Those eligible for treatment received combination therapy with pegylated interferon and ribavirin. Parameter estimates were obtained from literature searches and experts in the field.

Results. Few estimates of the uptake of HCV testing in primary care are available. Cost utility was estimated at around £16 000/QALY for both scenarios. At a willingness to pay of £30 000/QALY, there is approximately a 75% probability that the initiatives would be cost-effective. Choices regarding the utility data, discounting and the rates of spontaneous/re-presentation outside of a case-finding programme appear to be important areas of uncertainty in this model.

Conclusion. Case finding for HCV in primary care is likely to be considered cost-effective but substantial uncertainties remain. Further research is needed on different approaches to case finding in primary care.

Keywords: Case finding; cost-benefit analysis; hepatitis C; intravenous substance abuse; primary health care.
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