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

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 pounds sterling/QALY for both scenarios. At a willingness to pay of 30,000 pounds sterling/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.