Cost-effective universal screening for hepatitis C in France
It is currently recommended in Europe that screening for hepatitis C virus (HCV) should target people at high risk of infection. In France, public health data suggest that in 2014 approximately 75 000 people aged 18 to 80 were infected by HCV, but were unaware of their status. In at least one in ten cases, these people are at an advanced stage of the disease when diagnosed. Today's treatments of HCV infection are both highly effective and well tolerated, and cure the infection in a few weeks in over 95% of cases. In Professor Yazdan Yazdanpanah's Inserm research team, Sylvie Deuffic-Burban has developed a mathematical model that assesses the efficacy and cost-effectiveness of different screening strategies, including universal screening.
This study applied data from a 2004 InVS seroprevalence survey to 18- to 80-year-olds in France, excluding people with diagnosed chronic HCV infection. The researchers developed their analytical model using a combination of these seroprevalence data and findings from studies of the characteristics of people infected (age, sex, stage of the disease at diagnosis, alcohol intake, etc.), the natural progression of the disease, the efficacy of treatments, the quality of life of the patients treated, and the cost of treatment of infection. The screening strategies assessed targeted the following groups: the at-risk population only, all men aged between 18 and 59, all people aged between 40 and 59, all people aged between 40 and 80, and everyone aged between 18 and 80, ie, universal screening.
The modeling results show that universal screening is associated with better life expectancy adjusted for quality of life than other strategies. Universal screening is cost-effective if the patients tested for HCV infection are treated rapidly after diagnosis. Sylvie Deuffic-Burban points out that "Screening, on an individual basis, enables rapid treatment, which avoids the development of serious complications. In time, collective screening helps eliminate hepatitis C from a population that has been screened without restrictions." The results of this ANRS-funded study therefore argue in favor of universal screening for HCV in France, followed by immediate treatment of those diagnosed with HCV infection. Sylvie Deuffic-Burban concludes that "Although our model is unable to test the idea, the epidemiological similarities of HCV, HIV, and HBV suggest that universal and combined screening for these three viruses could be of particular interest."
Assessing the cost-effectiveness of hepatitis C screening strategies in France
Sylvie Deuffic-Burban1,2, Alexandre Huneau1, Adeline Verleene1, Cécile Brouard3, Josiane Pillonel3, Yann Le Strat3, Sabrina Cossais1, Françoise Roudot-Thoraval4, Valérie Canva5, Philippe Mathurin2,5, Daniel Dhumeaux6, Yazdan Yazdanpanah1,7
1 IAME, UMR 1137, Inserm, Université Paris Diderot, Sorbonne Paris Cité, Paris, France, 2 Université Lille, Inserm, CHU Lille, U995 – LIRIC – Lille Inflammation Research International Center, Lille, France, 3 Santé publique France, Saint-Maurice, France
4 Service Santé Publique, Hôpital Henri Mondor, Créteil, France, 5 Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, Lille, France, 6 Inserm U955, Hôpital Henri-Mondor, Créteil, France, 7 Service de maladies Infectieuses et tropicales, Hôpital Bichat Claude Bernard, Paris, France
The ANRS reviews, funds, and coordinates research programs on HIV/AIDS and hepatitis in various fields (basic research, clinical research, public health, vaccination). It brings together researchers and physicians from a whole range of disciplines, in both France and elsewhere. Its annual budget of about 50 million euros is in large part allocated by the ministries of research and health for one-off projects. An autonomous agency of Inserm since 2012, the ANRS funded 500 research projects and grants in 2017.
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