Screening for hepatitis C in genito-urinary medicine clinics: a cost utility analysis

Background/Aims : To estimate the cost utility (cost per QALY) of screening for hepatitis C (HCV) infection in people attending genito-urinary medicine clinics in England. Methods : An epidemiological model of screening and diagnosis was combined with a Markov chain model of treatment with combination therapy to estimate cost utility. Parameters for the model were informed by literature review, expert opinion and a survey of current screening practice. Results : The base case estimate was about £85,000 per QALY. Selective screening is more cost effective. If screening is restricted to only 20% or 10% of attenders, cost utility is estimated as £39,647 and £34,288 per QALY. If screening is restricted only to those with a history of injecting drug use, cost utility would be £27,138 per QALY. Estimates are particularly sensitive to acceptance rates for screening and treatment. Conclusions : Universal screening for HCV in GUM clinics is unlikely to be cost effective. There is limited evidence to support screening of people other than those with a history of injecting drug use and even this policy should be considered with some care and in the context of further research.