SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Très original
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Jean-Louis PAYEN
Coup de coeur :
 
 
Journal of Hepatology
  2018/10  
 
  2018 Oct;69(4):785-792.  
  doi: 10.1016/j.jhep.2018.05.027.  
 
  Assessing the cost-effectiveness of hepatitis C screening strategies in France  
 
  Deuffic-Burban S, Huneau A, Verleene A, Brouard C, Pillonel J, Le Strat Y, Cossais S, Roudot-Thoraval F, Canva V, Mathurin P, Dhumeaux D, Yazdanpanah Y  
  https://www.ncbi.nlm.nih.gov/pubmed/30227916  
 
 

Abstract

BACKGROUND & AIMS:

In Europe, hepatitis C virus (HCV) screening still targets people at high risk of infection. We aim to determine the cost-effectiveness of expanded HCV screening in France.

METHODS:

A Markov model simulated chronic hepatitis C (CHC) prevalence, incidence of events, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER) in the French general population, aged 18 to 80 years, undiagnosed for CHC for different strategies: S1 = current strategy targeting the at risk population; S2 = S1 and all men between 18 and 59 years; S3 = S1 and all individuals between 40 and 59 years; S4 = S1 and all individuals between 40 and 80 years; S5 = all individuals between 18 and 80 years (universal screening). Once CHC was diagnosed, treatment was initiated either to patients with fibrosis stage ≥F2 or regardless of fibrosis. Data were extracted from published literature, a national prevalence survey, and a previously published mathematical model. ICER were interpreted based on one or three times French GDP per capita (€32,800).

RESULTS:

Universal screening led to the lowest prevalence of CHC and incidence of events, regardless of treatment initiation. When considering treatment initiation to patients with fibrosis ≥F2, targeting all people aged 40-80 was the only cost-effective strategy at both thresholds (€26,100/QALY). When we considered treatment for all, although universal screening of all individuals aged 18-80 is associated with the highest costs, it is more effective than targeting all people aged 40-80, and cost-effective at both thresholds (€31,100/QALY).

CONCLUSIONS:

In France, universal screening is the most effective screening strategy for HCV. Universal screening is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of HCV eradication, this strategy should be implemented.

LAY SUMMARY:

In the context of highly effective and well tolerated therapies for hepatitis C virus that are now recommended for all patients, a reassessment of hepatitis C screening strategies is needed. An effectiveness and cost-effectiveness study of different strategies targeting either the at-risk population, specific ages or all individuals was performed. In France, universal screening is the most effective strategy and is cost-effective when treatment is initiated regardless of fibrosis stage. From an individual and especially from a societal perspective of hepatitis C virus eradication, this strategy should be implemented.

 

 
Question posée
 
Evaluation de la rentabilité des stratégies de dépistage de l'hépatite C en France.
 
Question posée
 
En France, le dépistage universel serait la stratégie la plus efficace et la plus rentable si le traitement est réalisé, quel que soit le stade de fibrose.
 
Commentaires

Cette stratégie devrait être soutenue par notre communauté afin qu’elle soit mise en œuvre pour obtenir une éradication du virus de l’hépatite C.

 
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