OBJECTIVE: To estimate the cost-effectiveness of birth-cohort screening. DESIGN: Cost-effectiveness simulation. DATA SOURCES: National Health and Nutrition Examination Survey, U.S. Census, Medicare reimbursement schedule, and published sources.TARGET POPULATION: Adults born from 1945 through 1965 with 1 or more visits to a primary care provider annually.TIME HORIZON: Lifetime.PERSPECTIVE: Societal, health care.INTERVENTION: One-time antibody test of 1945-1965 birth cohort.OUTCOME MEASURES: Numbers of cases that were identified and treated and that achieved a sustained viral response; liver disease and death from HCV; medical and productivity costs; quality-adjusted

life-years (QALYs); incremental cost-effectiveness ratio (ICER). RESULTS

OF BASE-CASE ANALYSIS: Compared with the status quo, birth-cohort screening identified 808,580 additional cases of chronic HCV infection Selleckchem C59 wnt at a screening cost of $2874 per case identified. Assuming that birth-cohort Fluorouracil in vivo screening was followed by pegylated interferon and ribavirin (PEG-IFN+R) for treated patients, screening increased QALYs by 348,800 and costs by $5.5 billion, for an ICER of $15,700 per QALY gained. Assuming that birth-cohort screening was followed by direct-acting antiviral plus PEG-IFN+R treatment for treated patients, screening increased QALYs by 532,200 and costs by $19.0 billion, for an ICER of $35,700 per QALY saved. RESULTS OF SENSITIVITY ANALYSIS: The ICER of birth-cohort screening was most sensitive to sustained viral response of antiviral therapy, the cost of therapy, the discount rate, and the QALY losses assigned to disease states. LIMITATION: Empirical data on screening and direct-acting antiviral treatment in real-world clinical settings are scarce. CONCLUSION: Birth-cohort screening for HCV in primary care medchemexpress settings was cost-effective. PRIMARY FUNDING SOURCE: Division of Viral Hepatitis, Centers for Disease Control and Prevention. Americans can always be counted on to do the right thing…after they have exhausted all other possibilities. Winston Churchill After all but ignoring screening for hepatitis C virus (HCV) for many years

(not for lack of will, but from lack of funding), the Centers for Disease Control and Prevention (CDC) has recommended universal screening for Baby Boomers.1 In the United States, HCV prevalence is the highest in those born between 1946 and 1970; 1 in 30 Baby Boomers are infected with HCV. The majority acquired hepatitis C decades ago, before it was even identified (1989).2 Even more troubling is that by 2020, at least one third of them will already have progressed to cirrhosis with its apocalyptic effect on health and healthcare costs.3 Up to three quarters of individuals infected with HCV in the United States are unaware of their HCV status.1 The CDC HCV screening recommendations were, until recently, exclusively targeting individuals with high-risk behaviors.