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Abstract: PO0811

Cost-Effectiveness of Hepatitis C Virus Testing Strategies in US Hemodialysis Centers

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Epstein, Rachel L., Boston University School of Medicine, Boston, Massachusetts, United States
  • Pramanick, Tannishtha, Boston Medical Center, Boston, Massachusetts, United States
  • Reese, Peter P., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Linas, Benjamin P., Boston University School of Medicine, Boston, Massachusetts, United States
  • Sawinski, Deirdre L., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
Background

The Centers for Disease Control and Prevention and the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend screening all patients for hepatitis C virus (HCV) infection prior to starting outpatient hemodialysis (HD), every 6 months thereafter, and every 1-3 months if a center outbreak is detected. Yet, the cost-effectiveness of such screening frequency is not clear. We therefore sought to compare the clinical and cost-effectiveness of HCV testing strategies in US hemodialysis centers.

Methods

We parameterized the Hepatitis C Cost-Effectiveness (HEP-CE) model to reflect the US HD population, using United States Renal Data System and literature data. We simulated HCV infection, progression, treatment, and outbreaks within dialysis centers at the literature-reported frequency (approximately 1%). We competed 5 strategies to compare clinical outcomes and cost-effectiveness of screening, ranging from no testing at all, to every 6-month HCV testing, each with every 3-month screening during a simulated outbreak in 1% of centers. We estimated life expectancy, quality-adjusted life years (QALYs), total HCV infections identified and cured, liver-related deaths, costs (US$ 2019) and incremental cost-effectiveness ratios (ICERs). We simulated cohorts of 100 million individuals over a 20-year time horizon and assumed a health sector perspective.

Results

With no HCV testing or treatment, average life expectancy was 5.22 years, with 2.5 million HCV infections, 678,350 cirrhotic individuals, and 182,646 deaths from liver disease (Table 1). Screening only at HD initiation increased HCV cure rates by 77% and decreased liver deaths by 79%, with an ICER of $71,533 per QALY saved compared to no screening. Increasing screening to every 2 years decreased liver-related deaths by an additional 51% with an ICER of $119,853 over screening at HD entry only. Screening annually or every 6 months was not cost-effective using a willingness to pay threshold of $150,000, even with halving baseline mortality rates or perfect linkage to care.

Conclusion

Testing for HCV in HD provides good economic value, but current CDC and KDIGO recommended intervals are not cost-effective.

Funding

  • NIDDK Support