Shin Gyeongseon, Kim Beom Kyung, Bae SeungJin, Lee Hankil, Ahn Sang Hoon
College of Pharmacy, Ewha Womans University, Seoul, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Clin Mol Hepatol. 2025 Jan;31(1):166-178. doi: 10.3350/cmh.2024.0484. Epub 2024 Oct 4.
BACKGROUND/AIMS: The World Health Organization (WHO) aims to eliminate hepatitis C virus (HCV) by 2030; therefore, widespread HCV screening is required. The WHO recommends HCV self-testing (HCVST) as a new approach. We aimed to evaluate disease burden reduction using the HCVST screening strategy and identify the most cost-effective approach.
We developed a dynamic open-cohort Markov model to assess the long-term effects and costeffectiveness of HCVST in the Republic of Korea from 2024 to 2030. Strategies for comparison included universal, birth cohort, high-risk group screening, and no screening, focusing on the following: (1) incremental costeffectiveness ratio (ICER) per disability-adjusted life-year (DALY) saved; (2) severe liver disease cases; and (3) liverrelated death reduction.
Universal HCVST screening is the most effective strategy for achieving the WHO goal by 2030, substantially lowering the incidence of severe liver disease by 71% and preventing liver-related deaths by 69%, thereby averting 267,942 DALYs. Moreover, with an ICER of US$8,078 per DALY and high cost-effectiveness, the sensitivity results prove that cost-effectiveness is robust. Although high-risk group screening offers the lowest cost compared with other strategies, its effectiveness in preventing severe liver disease is minimal, falling short of the current WHO goal.
Our study confirms that universal HCVST screening is a cost-effective strategy aligned with the WHO goal to eliminate HCV by 2030. Despite its higher costs compared to risk-based screening, the disease burden can be significantly reduced by providing effective HCVST access to individuals who might otherwise not be tested.
背景/目的：世界卫生组织（WHO）旨在到2030年消除丙型肝炎病毒（HCV）；因此，需要进行广泛的HCV筛查。WHO推荐HCV自我检测（HCVST）作为一种新方法。我们旨在评估使用HCVST筛查策略降低疾病负担的情况，并确定最具成本效益的方法。
我们建立了一个动态开放队列马尔可夫模型，以评估2024年至2030年在大韩民国进行HCVST的长期效果和成本效益。比较策略包括普遍筛查、出生队列筛查、高危人群筛查和不筛查，重点关注以下方面：（1）每挽救一个伤残调整生命年（DALY）的增量成本效益比（ICER）；（2）严重肝病病例；（3）减少肝脏相关死亡。
普遍进行HCVST筛查是到2030年实现WHO目标的最有效策略，可大幅降低严重肝病发病率71%，预防肝脏相关死亡69%，从而避免267,942个DALY。此外，每DALY的ICER为8,078美元，成本效益高，敏感性结果证明成本效益是稳健的。尽管与其他策略相比，高危人群筛查成本最低，但其预防严重肝病的效果微乎其微，未达到当前WHO目标。
我们的研究证实，普遍进行HCVST筛查是一种符合WHO到2030年消除HCV目标的具有成本效益的策略。尽管与基于风险的筛查相比成本较高，但通过为那些否则可能无法接受检测的个体提供有效的HCVST检测，可以显著降低疾病负担。
