The Costs and Benefits of Expanding Hepatitis C Screening in the Indian Health Service

Publisher: Washington, DC: Mathematica Policy Research
Oct 26, 2018
Divya Vohra, Monica Huang, and So O’Neil

Key Findings:

  • Expanding HCV screening in the IHS service population to include all women of reproductive age or universal screening for all individuals ages 15–64 would be cost-beneficial in the long term at a seroprevalence of 0.20 percent or above. Studies estimate seroprevalence in AI/AN populations to be higher than 0.20 percent, ranging from 0.82 percent to11.5 percent (McMahon et al. 2004; Mera et al. 2016; Neumeister et al. 2007).
  • The model to identify the seroprevalence threshold at which expanded screening becomes cost-beneficial is highly sensitive to the cost of the drugs used to treat HCV. If more expensive drugs are used, the seroprevalence at which screening becomes cost-beneficial rises to as much as 10.0 percent. Given the range of seroprevalence estimates for AI/AN populations, it is likely that expanded screening would be cost-beneficial even if more expensive drugs are used, but expanded screening is unlikely to be cost-beneficial if the majority of HCV-positive patients receive the most expensive drug regimens currently available.

To determine the conditions under which expanding screening and treatment could be cost-beneficial to the Indian health care system, this study seeks to identify the specific population seroprevalence at which the net costs of expanding screening, including any savings from averting costly HCV-related sequelae, balance the net costs of the current screening approach. It also describes how recommendations for screening expansion might change for different IHS subpopulations.