Abstract

Background Hepatitis C virus (HCV) causes significant global morbidity and mortality, and combating it is a global health priority. Pakistan has a particularly high burden of HCV, including cases that remain undetected and untreated.

Methods In 2019, a pilot workplace health screening program for chronic diseases, including HCV, was launched at Aga Khan University in Pakistan. We performed an economic evaluation to determine its cost-effectiveness in screening for HCV, inform resource allocation decisions, and advance evidence in this field. Over the course of the screening pilot, 1,809 employees completed enrollment, blood tests, assessment, and consultation. Cost-effectiveness modeling was conducted using a combination of decision-tree and Markov approaches. Univariate and multivariate probabilistic sensitivity analyses were performed.

Results The median final ICER was $307.39 per DALY averted. Uncertainty around the health status of those lost to follow-up produced a large confidence interval, from $167.92 to $1601.22 per DALY averted, depending on the assumptions made. This screening is estimated to save anywhere from 1 to 14 lives by prevention of HCV-induced liver failure, depending on the burden of HCV in the lost to follow-up group, out of a total of 25 HCV-induced liver failure deaths in the control group, between a 44% and a 4% reduction.

Conclusions Our findings support that employee screening for HCV is cost-effective in high-prevalence areas such as Pakistan and a wise investment of health resources. The findings also point to programmatic improvements that could maximize the health benefits and improve the cost-effectiveness of other similar programs.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any formal funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Ethics Review Committee (ERC) of Aga Khan University, Karachi, Pakistan gave ethical approval of the project

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

All data produced in the present study are available upon reasonable request to the authors

AbbreviationsEHWPEmployee Health and Wellness ProgramHCVHepatitis C VirusOOPOut of pocket expenditureICERIncremental cost-effectiveness ratio