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A COST-EFFECTIVENESS ANALYSIS OF HEPATITIS C SCREENING AMONG IMMIGRANTS IN CANADA

W Chen¹, K Dinner², T Wong², J Heathcote¹, M Krahn¹
¹Department of Medicine, University of Toronto, Toronto, Ontario ²Public Health Agency of Canada (PHAC)

AIM: The costs and benefits of hepatitis C (HCV) screening among immigrants need to be assessed since about 20% of HCV cases in Canada are immigrants.
METHODS: A decision analytic model was developed to assess HCV screening among immigrants. The prevalence of hepatitis C and distributions of viral genotypes among immigrants were projected by the studies related to HCV epidemiology in their home countries. Meta-analyses of randomized trials were conducted to estimate the effectiveness of current anti-viral therapy (pegylated interferon plus ribavirin) in terms of genotype and disease stage. Survival regression model and logistic regression model were applied to project the transition probabilities for the disease progression by identifying cohort studies on the natural history of chronic HCV. The awareness of the disease, and the HCV incidence among immigrants were estimated using PHAC's surveillance data. The costs associated with HCV screening test, anti-viral therapy, and health care were estimated through published literatures. Cost-effectiveness analysis for immigrants was further stratified by world regions.
RESULTS: HCV screening was associated with an increase of life years (0.0013 years) and cost ($40.6) when compared to no screening for all immigrants ($30,552 per additional life year). HCV screening for immigrants born in South Asia was associated with longer life years (0.0108 years) and less cost ($50.6). HCV screening strategy for immigrants born in Africa cost $8,635 to gain one additional life year. No obvious advantages of HCV screening were observed for immigrants from other areas.
CONCLUSION: The preliminary findings suggest that it may be cost-effectiveness to screen immigrants from South Asia and Africa. However, further studies are needed.

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