Cost-benefit analysis of universal screening for HCV infection in China: a Markov modelling study.

Abstract

Background: Hepatitis C virus (HCV) infection remains a major public health concern in China, contributing substantially to global HCV-related morbidity and mortality. In line with the World Health Organization (WHO) targets for HCV elimination by 2030, this study aimed to evaluate the long-term health and economic outcomes of universal HCV screening strategies in China.

Methods: A decision-analytic Markov model was developed to simulate HCV disease progression and healthcare costs over a 30-year time horizon (2026-2055). A total of 81 scenarios were assessed, including 80 universal screening strategies and a no-screening comparator. Strategies varied by age group (3-10, 20-60, 60-80, or 3-80 years), screening duration (10 or 30 years), and frequency (once in 2026, or repeated every 10, 5, 3, 2 years, or annually). Model inputs were derived from published literature and national data. Cost-effectiveness was evaluated using a willingness-to-pay (WTP) threshold based on China's 2023 per capita gross domestic product, with future costs and health outcomes discounted at 5% annually. Deterministic and probabilistic sensitivity analyses were conducted.

Results: Universal HCV screening was both effective and cost-effective in the majority of scenarios, with 74 out of 80 strategies demonstrating favorable cost-effectiveness ratios. Eighteen strategies met the WHO target for HCV-related mortality reduction before 2040. The most cost-effective approach-screening individuals aged 3-80 years every 5 years for 10 years-yielded an incremental net monetary benefit of US$98.99 billion (95% CI: US$10.18-190.15 billion), while reducing healthcare expenditures by US$126.67 billion compared to no screening. The required investment for screening was US$3.24 billion. Findings were robust in sensitivity analyses.

Conclusions: Universal HCV screening every 5 years for individuals aged 3-80 years over a 10-year period is highly cost-effective in China and supports national efforts toward achieving WHO HCV elimination targets. These results provide evidence to inform policy decisions in China and other middle-income settings.