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Hepatitis C core antigen test as an alternative for diagnosing HCV infection: mathematical model and cost-effectiveness analysis

Butsashvili, Maia
Shilton, Sonjelle
Tskhomelidze, Irina
Tsereteli, Maia
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Published in PeerJ. 2021, vol. 9, e11895

Background: The cost and complexity of the polymerase chain reaction (PCR) test are barriers to diagnosis and treatment of hepatitis C virus (HCV) infection. We investigated the cost-effectiveness of testing strategies using antigen instead of PCR testing.

Methods: We developed a mathematical model for HCV to estimate the number of diagnoses and cases of liver disease. We compared the following testing strategies: antibody test followed by PCR in case of positive antibody (baseline strategy); antibody test followed by HCV-antigen test (antibody-antigen); antigen test alone; PCR test alone. We conducted cost-effectiveness analyses considering either the costs of HCV testing of infected and uninfected individuals alone (A1), HCV testing and liver-related complications (A2), or all costs including HCV treatment (A3). The model was parameterized for the country of Georgia. We conducted several sensitivity analyses.

Results: The baseline scenario could detect 89% of infected individuals. Antibody-antigen detected 86% and antigen alone 88% of infected individuals. PCR testing alone detected 91% of the infected individuals: the remaining 9% either died or spontaneously recovered before testing. In analysis A1, the baseline strategy was not essentially more expensive than antibody-antigen. In analysis A2, strategies using PCR became cheaper than antigen-based strategies. In analysis A3, antibody-antigen was again the cheapest strategy, followed by the baseline strategy, and PCR testing alone.

Conclusions: Antigen testing, either following a positive antibody test or alone, performed almost as well as the current practice of HCV testing. The cost-effectiveness of these strategies depends on the inclusion of treatment costs.

Keywords AntigenCountry of GeorgiaDiagnostic testHCVHepatitis CMathematical modelingPCRPolymerase chain reactionProgression modelScreening strategies
PMID: 34595063
PMCID: PMC8436958
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Article (Published version) (925 Kb) - public document Free access
Appendix (921 Kb) - public document Free access
Dataset: https://github.com/maryamsadeghimehr/HCV_Antigen
Research groups Etudes et traitement de l'hépatite C et B (554)
Maladies infectieuses et modèles mathématiques (988)
Swiss National Science Foundation: 33CS30_177521
Swiss National Science Foundation: PP00P3_163878
(ISO format)
SADEGHIMEHR, Maryam et al. Hepatitis C core antigen test as an alternative for diagnosing HCV infection: mathematical model and cost-effectiveness analysis. In: PeerJ, 2021, vol. 9, p. e11895. doi: 10.7717/peerj.11895 https://archive-ouverte.unige.ch/unige:156710

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Deposited on : 2021-11-24

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