Objective: To compare the costs and cost-effectiveness (C/E) of early HCV-RNA testing (alternative-US recommendations) after occupational exposure to HCV to existing follow up strategies: French, anti-HCV antibodies and alanine transaminase (ALT) activity at months 1, 3, and 6; European, monthly of ALT activity for 4 months and anti-HCV antibodies at month 6; and Baseline-US, anti-HCV antibodies and ALT activity at month 6.
Design and setting: A decision tree simulated each strategy for 7,300 health care workers (HCWs) exposed to HCV each year in France taking into account the impact of early diagnosis on the response to antiviral treatment and the deterioration of HCW quality of life after exposure.
Results: For a HCV transmission risk of 0.5% after exposure, the French strategy led to the highest costs/person (€181.40) and the baseline-US to the lowest (€126.60) (€178.50 for alternative-US). The shortest mean time to HCV infection diagnosis (1 month) and the lowest number of chronic hepatitis C (CHC) patients (1.9/7300 HCWs exposed) was obtained with the alternative-US (vs. 6 months and 7.9 CHC, respectively with baseline-US). Compared to the alternative-US, the French strategy was associated with higher costs and lower utilities, and the European with higher incremental C/E ratio. Compared to the baseline-US, the alternative-US strategy C/E ratio was €2,020/quality-adjusted life years saved.
Conclusion: In HCWs exposed to HCV, a strategy based on early HCV-RNA testing shortens the period during which the HCW's wait for his HCV status, leads to lower risk of progression to chronic hepatitis C, and is reasonably cost-effective.