Cost-effectiveness of hepatitis C screening and treatment in low-income, primarily hispanic baby boomers

The cost- effectiveness of hepatitis C virus (HCV) screening and treatment was examined in low-income, primarily Hispanic baby boomers born 1945- 1965 using a Markov model of the natural history of HCV. The model was parameterized using costs and diagnostic data from 2008- 2016 and from literature on disease progression and effectiveness of screening and treatment using direct acting anti- viral (DAA) therapy. The incremental cost- effectiveness ratio (ICER) was computed from the perspective of Medicare as payer, calculated over 20 years, and discounted at 3% per year. In the base case, HCV screening cost $3,334 versus $3,797 for no screening, and yielded more quality- adjusted life years (QALYs; 14.08 vs 13.96, respectively). The ICER for screening was still less than $20,000 per additional QALY with drug costs up to $100,000. Among low-income Hispanics, HCV screening was less costly for Medicare and more effective than no screening under most assumptions. This analysis supports investment in screening and treatment in Hispanics.