We agree with Shah and colleagues1 that the growing burden of chronic hepatitis C virus (HCV) infection poses a substantial public health concern. Managing HCV is difficult, because HCV is clinically silent for the majority of those infected. If HCV is not recognized and patients are not treated, they may present with late-stage disease and potentially fatal complications. Universal screening and screening for HCV among high-risk groups in Canada are plausible strategies.
However, we need information on the potential effects on health, costs and cost-effectiveness of implementing either a universal or a selective screening program. A screening program will identify many people who require treatment, which will mean substantial costs to our health care system. Currently, cost is a salient issue because of the many new and expensive HCV treatment regimens in the drug pipeline. Although effective, these regimens are expensive (e.g., one approved drug costs about $45 000 for a 24-week course). Future drugs may be even more expensive2 and may cause adverse events.
We need to build a model that can project the health and economic effects of various HCV screening strategies conducted in different populations in Canada. Borrowing results from studies conducted in other countries may not reflect the situation (e.g., cost, patterns of care, disease epidemiology) in Canada.
Members of our group are collaborating with the Public Health Agency of Canada and the Canadian Agency for Drugs and Technologies in Health to perform economic evaluations on both screening as well as treatment for HCV in a Canadian setting. We hope that the results of our disease modelling will improve the scientific evidence around screening and drug treatment decisions.