Cost Effectiveness of Screening for Hepatitis C Virus in Iraq in the Era of Simplified Testing and Treatment

Bassem Asker, Raghad Jawad, Rabah Asreah, Haydar Jamal, Ahmed Jassem, Muslim Abdelkareem Inaya, Hiwa Abou Baker, Sam Kozma, Eid Mansour, Bryony McNamara, Ryan Miller, Oliver Darlington, Phil McEwan, Daniel M. Sugrue () and Haidar Jarallah
Additional contact information
Bassem Asker: GIT Center
Raghad Jawad: GIT Center
Rabah Asreah: Baghdad Teaching Hospital
Haydar Jamal: Sulaimania Hospital
Ahmed Jassem: Najaf Hospital
Muslim Abdelkareem Inaya: Najaf Hospital
Hiwa Abou Baker: Sulaimania Hospital
Sam Kozma: Gilead Sciences
Eid Mansour: Gilead Sciences
Bryony McNamara: Health Economics and Outcomes Research Ltd
Ryan Miller: Health Economics and Outcomes Research Ltd
Oliver Darlington: Health Economics and Outcomes Research Ltd
Phil McEwan: Health Economics and Outcomes Research Ltd
Daniel M. Sugrue: Health Economics and Outcomes Research Ltd
Haidar Jarallah: Basra Hospital

PharmacoEconomics, 2021, vol. 39, issue 11, No 8, 1327-1341

Abstract: Abstract Background and Objective Recent advances in hepatitis C virus (HCV) diagnostic testing methods allow for a one-stop simplified ‘test and cure’ approach. The cost effectiveness of incorporating this simplified approach into HCV screening in Iraq remains uncertain. This study aimed to compare the cost effectiveness of different HCV testing and diagnostic approaches, and screening strategies in Iraq from a health service perspective. Methods A cost-effectiveness analysis was undertaken using a hybrid model comprising a screening decision tree linked to a lifetime Markov model to estimate outcomes in HCV-infected people. Cost and utility estimates were sourced from the published literature and expert guidance provided by clinicians and policy makers in Iraq. Cost estimates were reported in 2019 USD or 2019 Iraqi Dinar and both costs and benefits were discounted at 3.5% annually. Results Strategies using a simplified approach were found to be cost saving in addition to improving patient outcomes when compared with a standard testing and diagnostic approach. When considering risk-based screening, a simplified approach was associated with a total cost saving of Iraqi Dinar 4375 billion (USD 3.7 billion) and per patient life-year and quality-adjusted life-year gains of 0.30 and 0.55, compared with a standard approach. Benefits and cost savings were driven by a 32.2% and 23.6% reduction in the incidence of cirrhosis and hepatocellular carcinoma, respectively. Estimated benefits and cost savings increased under total population screening. All screening and testing and diagnostic approaches were cost effective compared with a no screening scenario. Conclusions Improvements in the detection of HCV combined with a simplified one-stop testing and diagnostic approach represents an opportunity to reduce the burden of HCV in Iraq and may play a significant role in meeting World Health Organisation HCV elimination targets.

Date: 2021
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DOI: 10.1007/s40273-021-01064-z

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