Cost-effectiveness analysis of strategies for hepatitis C screening in French blood recipients

Background: In a context of scarce health resources and varied medical practices, the aim of this study was to compare cost-effectiveness of different screening strategies for hepatitis C virus among blood recipients. Methods: A cost-effectiveness model was used to test nine screening strategies in three survival categories. Three Markov models were used for three methods of follow-up. The marginal cost-effectiveness ratio was estimated to compare the screening strategies. Results: Hepatitis C virus serology by enzyme-linked immunosorbent assay and confirmation by detection of the virus RNA was proved to be the dominant strategy. The marginal cost-effectiveness ratios were for subjects under 40 and low-volume transfusion patients, 776,474 and 2,636,500 French Francs-1996 (about USD 111,000 and 376,650) per life-year gained, respectively. Sensitivity analysis showed that the marginal cost-effectiveness ratio was influenced by the prevalence and the survival rates. The lower marginal cost-effectiveness ratio was estimated at 690,221 French Francs- 1996 per life-year gained. Conclusion: This study showed high costs and few life-years gained for the dominant strategy even for the more favourable risk group. New studies may be carried out for new screening and therapeutic strategies.