Economic evaluation of an employee health screening program for Hepatitis C virus in Pakistan

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 preventing 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.