ArticlePloS one2020
Model-based cost-effectiveness estimates of testing strategies for diagnosing hepatitis C virus infection in Central and Western Africa.
Article in PloS one, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed, 24 citations in OpenAlex.
- Performance Evaluation of the Xpert® HCV Test on Fingerstick Blood in a Prospective Observational Clinical Study at CLIA-Waived Sites in the United States.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Observational
- Cost and cost-effectiveness of alternative screening and diagnostic pathways for achieving hepatitis C elimination in the country of Georgia.PLOS global public health · 2026Article
- Sensitivity and specificity of dried blood spot samples for hepatitis C virus RNA testing.BMC infectious diseases · 2025Article
- Article
- Molecular Point-of-Care Testing for Hepatitis C: Available Technologies, Pipeline, and Promising Future Directions.The Journal of infectious diseases · 2024Review
- A handheld luminometer with sub-attomole limit of detection for distributed applications in global health.PLOS global public health · 2024Article
- Point-of-Care Testing for Hepatitis Viruses: A Growing Need.Life (Basel, Switzerland) · 2023Review
- Optimizing point-of-care testing strategies for diagnosis and treatment of hepatitis C virus infection in Australia: a model-based cost-effectiveness analysis.The Lancet regional health. Western Pacific · 2023Article
- Assessing feasibility of a modified same-day test-and-treat model for hepatitis C among rural people who inject drugs.Harm reduction journal · 2023Article
- Quality Assurance for Hepatitis C Virus Point-of-Care Diagnostics in Sub-Saharan Africa.Diagnostics (Basel, Switzerland) · 2023Review
- Hepatitis C virus: A critical approach to who really needs treatment.World journal of hepatology · 2022Review
- Evaluation of Hepatitis C Virus Core Antigen Assay in a Resource-Limited Setting in Pakistan.Diagnostics (Basel, Switzerland) · 2021Article
- HCV Diagnosis and Sequencing Using Dried Blood Spots from Patients in Kinshasa (DRC): A Tool to Achieve WHO 2030 Targets.Diagnostics (Basel, Switzerland) · 2021Article
Corrections and comments
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Authors and funding
10 authors at 8 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhereas 72% of hepatitis C virus (HCV)-infected people worldwide live in low- and middle-income countries (LMICs), only 6% of them have been diagnosed. Innovative technologies for HCV diagnosis provide opportunities for developing testing strategies more adapted to resource-constrained settings. However, studies about their economic feasibility in LMICs are lacking.
methodsAdopting a health sector perspective in Cameroon, Cote-d'Ivoire, and Senegal, a decision tree model was developed to compare 12 testing strategies with the following characteristics: a one-step or two-step testing sequence, HCV-RNA or HCV core antigen as confirmative biomarker, laboratory or point-of-care (POC) tests, and venous blood samples or dried blood spots (DBS). Outcomes measures were the number of true positives (TPs), cost per screened individual, incremental cost-effectiveness ratios, and nationwide budget. Corresponding time horizon was immediate, and outcomes were accordingly not discounted. Detailed sensitivity analyses were conducted.
findingsIn the base-case, a two-step POC-based strategy including anti-HCV antibody (HCV-Ab) and HCV-RNA testing had the lowest cost, €8.18 per screened individual. Assuming a lost-to-follow-up rate after screening > 1.9%, a DBS-based laboratory HCV-RNA after HCV-Ab POC testing was the single un-dominated strategy, requiring an additional cost of €3653.56 per additional TP detected. Both strategies would require 8-25% of the annual public health expenditure of the study countries for diagnosing 30% of HCV-infected individuals. Assuming a seroprevalence > 46.9% or a cost of POC HCV-RNA < €7.32, a one-step strategy based on POC HCV-RNA dominated the two-step POC-based strategy but resulted in many more false-positive cases.
conclusionsPOC HCV-Ab followed by either POC- or DBS-based HCV-RNA testing would be the most cost-effective strategies in the study countries. Without a substantial increase in funding for health or a dramatic decrease in assay prices, HCV testing would constitute an economic barrier to the implementation of HCV elimination programs in LMICs.
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