Hepatitis C prevalence in the psychiatric setting: cost-effectiveness of scaling-up screening and direct-acting antiviral therapy

ABSTRACT Background & Aims People hospitalised due to mental illness often have risk factors for contracting hepatitis C virus (HCV). Scaling-up HCV screening for all psychiatric inpatients as a case-detection strategy for viral elimination is under-explored. This study aimed to evaluate the cost-effectiveness of scaling-up HCV screening and treatment for psychiatry hospital admissions in Switzerland versus the current standard-of-care risk-based approach, where only those with a history of substance misuse disorder are offered testing. Methods HCV prevalence by history of substance misuse disorder was analysed in medical records from inpatient admissions at a Swiss psychiatry department. Cost-effectiveness was analysed from a healthcare provider perspective through a decision-tree screening model, using this HCV prevalence data. We assessed model and parameter uncertainty using deterministic and probabilistic sensitivity analyses. Results Prevalence of HCV in psychiatry inpatients with a history of substance misuse disorder (n=1,013) was 25.7%, compared with 3.49% among the remaining inpatients (n=3,535). Scaling-up HCV screening and treatment for all psychiatry admissions was cost-effective versus the risk-based approach, with an incremental cost-effectiveness ratio of $9,188 per quality-adjusted life-year gained. The incremental cost-effectiveness ratio remained cost-effective considering HCV prevalence as low as 0.07%. The population-level net monetary benefit of the generalised screening approach was $435,156,348, with 917 additional patients per year detected and treated at a cost of $3,294 per person (versus $2,122 under the risk-based screening). Conclusions Scaling-up HCV screening and treatment at diagnosis with all-oral, interferon-free regimens as a generalised approach for psychiatric admissions was cost-effective and may support reaching World Health Organization targets for HCV elimination by 2030. LAY SUMMARY People hospitalised due to mental illness often have risk factors for hepatitis C virus (HCV). We found that testing all psychiatry patients in hospital for HCV was cost-effective compared to testing only patients who have a history of substance misuse. Scaling-up HCV testing and treatment may help to wipe out HCV. Clinical trial number Not applicable