The testing of people with any risk factor for Hepatitis C in community pharmacies is cost effective.

Abstract

New antiviral drugs with high efficacy mean the Hepatitis C virus (HCV) can now be eliminated. To achieve this it is necessary to identify undiagnosed cases of HCV. However, the costs of testing should be considered when judging the overall cost-effectiveness of treatment. This study describes the cost-effectiveness of a community pharmacy testing service in a population of people at risk of HCV living on the Isle of Wight (United Kingdom). Dry blood spot testing was conducted in anyone with a known risk factor for HCV in 20 community pharmacies. The outcomes and costs were entered into a Markov model. Cost and health utilities from the model were used to calculate an incremental cost-effectiveness ratio (ICER). In 24 months 186 tests were conducted, 13 were positive for HCV RNA and six of these (46%) received treatment during the follow up period. All achieved a sustained virological response at three months. The overall cost of the testing and treatment intervention was £242,183 and the ICER for the service was £3689 per quality adjusted life year (QALY) gained. If screening had been restricted to just people with a history of injecting drug use (PWID) the ICER would have been £4865 per QALY gained. The service was effective at identifying people with HCV infection and despite the additional cost of targeted testing its cost-effectiveness was below commonly accepted thresholds. In this setting, restricting targeted testing to PWID would not improve the cost-effectiveness.