Birth Cohort Screening (1945–1965) and Treatment for Hepatitis C Virus Infection
Prevention Case Study 4
Hepatitis C virus (HCV) can cause a serious and sometimes fatal infection of the liver. The virus is spread primarily when blood from an infected person enters the body of someone who is not infected. For some persons, HCV causes only a mild illness lasting a few weeks. For the majority of infected persons, however, untreated HCV causes a serious, chronic illness. In the United States, approximately 3.5 million persons are living with chronic HCV infection,1 50% of whom have not been tested and do not know their HCV status.2 Without screening and diagnosis, these persons cannot take the first step toward lifesaving treatment. Without treatment, persons with chronic HCV infection can die prematurely. Approximately 20,000 persons die in the United States each year because of chronic HCV infection-related causes.3
In 2012, CDC recommended that all persons born during 1945–1965 (i.e., Baby Boomers) receive at least one lifetime screening test for HCV, targeting the 2.7–3.9 million persons estimated to be living with HCV infection at that time.4
Birth-Cohort HCV screening and treatment programs save lives and money.
Birth-cohort screening identifies more persons with HCV infection than specific behavior risk-based screening5. By using a cost-effectiveness simulation, birth-cohort screening would identify 808,580 additional cases of chronic HCV infection, compared with risk-based screening.5
Treatment for HCV infection can be cost savings from both a societal and payer perspective. A systematic review revealed that the median price at which hepatitis C treatment becomes cost-saving is $70,900 (interquartile range: $43,300–$103,700) in 2014 US dollars,6 and the cost of most HCV treatment regimens are now far below that threshold.
Insurance companies negotiate the lowest prices they are willing to pay for medications. For example, in 2016, the average net cost of a 12-week course of treatment was $47,1247 under some commercial insurance plans. Additionally, ongoing competition and continued innovation regarding HCV infection treatment has led to new, more broadly effective medications at lower list prices. For example, one new drug is listed at $26,400 for an 8-week treatment course.8
With an estimated 1.7 million persons living with undiagnosed chronic HCV infection in the United States, routine screening and treatment programs for persons born during 1945–1965 are urgently needed to save lives in addition to money. 1,2
- Edlin BR, Eckhardt BJ, Shu MA, Holmberg SD, Swan T. Toward a more accurate estimate of the prevalence of hepatitis C in the United States. Hepatology 2015;62:1353–63.
- Denniston MM, Klevens RM, McQuillan GM, Jiles RB. Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001–2008. Hepatology 2012;55:1652–61.
- Centers for Disease Control and Prevention (CDC). Surveillance for viral hepatitis–United States, 2015. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/hepatitis/statistics/2015surveillance/index.htm.
- Centers for Disease Control and Prevention. Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recommend Rep 2012;61(No. RR-4):1–32.
- Rein DB, Smith BD, Wittenborn JS, et al. The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings. Ann Intern Med 2012;156:263–70.
- Chhatwal J, He T, Hur C, Lopez-Olivo MA. Direct-acting antiviral agents for patients with hepatitis C virus genotype 1 infection are cost-saving. Clin Gastroenterol Hepatol 2017;15:827–37.
- Express Scripts®. 2016 Drug trend report: commercial. St. Louis, MO: Express Scripts Holding Company; 2016. http://lab.express-scripts.com/lab/drug-trend-report/commercial-drug-trend-reportexternal icon.
- Seeking Alphaα. What AbbVie’s Mavyret approval means to Gilead. Ra’Anana, Israel: Seeking Alpha, Ltd. 2017. https://seekingalpha.com/article/4096805-abbvies-mavyret-approval-means-gileadexternal icon.