Economic evaluation to evidence-based policy: birth cohort testing for hepatitis C in Ireland
Aim: This thesis employed a range of health economic and evidence synthesis methods to inform evidence-based policy. To illustrate the utility of these methods, the potential introduction of birth cohort testing for hepatitis C virus (HCV) for people born between 1965 and 1985 was adopted as an applied example in the Irish decision-making context.
Methods and results: Three inter-related studies, based on a variety of health economic evaluation and evidence synthesis methodologies, were conducted to inform the decision problem. Study 1 comprised a systematic review and meta-analysis of 43 studies assessing the diagnostic test accuracy of dried blood spot (DBS) samples, which could enable expanded use of reflex testing, to detect HCV compared with venous blood samples. The pooled sensitivity of anti-HCV, RNA and antigen tests in DBS were 95%, 95% and 86%, respectively. The pooled specificity of anti-HCV, RNA and antigen tests in DBS were 99%, 97% and 98%, respectively. However, there was insufficient evidence regarding antigen tests in DBS and further research is required.
Study 2 comprised a systematic review of 27 studies assessing the cost-effectiveness of population-based HCV testing approaches. Compared with no testing or risk-based testing: 14 of 16 studies found that birth cohort testing was cost-effective, eight of nine found that universal testing was cost-effective and eight of eight found that age-based general population testing was cost-effective. However, the international literature was clinically and methodologically heterogeneous and not directly applicable to the Irish context. Therefore, Study 3 comprised a de novo economic evaluation of offering birth cohort testing to people in Ireland born between 1965 and 1985. The analysis found that systematic birth cohort testing would be cost-effective at a willingness-to-pay threshold of €20,000. This finding was robust across a range of sensitivity analyses.
Conclusion: The findings from this thesis suggest that the introduction of a systematic birth cohort testing programme for HCV, based on reflex testing, would be a cost-effective use of 14 resources in Ireland. The use of DBS could facilitate reflex testing and should be considered as part of a national birth cohort testing programme.
History
First Supervisor
Prof. Susan M. SmithSecond Supervisor
Prof. Paddy GillespieThird Supervisor
Ms Michelle O’NeillComments
Submitted for the Award of Doctor of Philosophy to RCSI University of Medicine and Health Sciences, 2023Published Citation
Carty P,. Economic Evaluation to Evidence-Based Policy: Birth Cohort Testing for Hepatitis C in Ireland. [PhD Thesis] Dublin: RCSI University of Medicine and Health Sciences; 2023Degree Name
- Doctor of Philosophy (PhD)
Date of award
2023-05-31Programme
- Doctor of Philosophy (PhD)