Optimizing HCV Screening to Maximize Health Benefit Among Men Who Have Sex with Men in the United States: A Cost-Effectiveness Analysis

Background: Current US guidelines recommend annual HCV screening among men who have sex with men (MSM) with HIV and MSM on pre-exposure prophylaxis against HIV (PrEP), but these recommendations were based largely on expert opinion using interferon-era assumptions.
Methods: We calibrated a dynamic economic model of HCV transmission among MSM to US data to determine the cost-effectiveness of HCV testing among MSM with HIV and/or using PrEP; and among MSM not using PrEP, compared to status quo HCV testing. Program costs and quality-adjusted life years (QALYs) were calculated to determine the mean incremental cost-effectiveness ratio (ICER) of each testing combination compared to its next least costly permutation. We defined the optimal strategy as that having the highest health benefits but with an ICER below a willingness-to-pay threshold of $100,000/QALY gained.
Results: Six testing strategies dominated the other combinations. Implementing recommended annual screening among MSM with HIV was cost-saving compared to current testing rates. However, the optimal strategy was testing MSM with HIV every 6 months, MSM using PrEP every 12 months, and MSM not using PrEP when tested for HIV (ICER $67,092/QALY gained). The optimal strategy did not change under sensitivity analyses.
Conclusions: The optimal frequency of HCV testing to achieve maximum health benefit in a cost-effective manner for MSM in the US is higher in two subgroups, MSM with HIV, and MSM not using PrEP, than current US guidelines recommend. HCV testing is currently performed less frequently than optimal. Expanding testing is needed to improve HCV outcomes among MSM in the US.