{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T07:26:51Z","timestamp":1773300411805,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T00:00:00Z","timestamp":1633651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Optimized diagnostic algorithms to detect active infections are crucial to achieving HCV elimination. We evaluated the cost effectiveness and sustainability of different algorithms for HCV active infection diagnosis, in a context of a high endemic country for HCV infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Markov disease progression model, simulating six diagnostic algorithms in the birth cohort 1969\u20101989 over a 10\u2010year horizon from a healthcare perspective was used. Conventionally diagnosis of active HCV infection is through detection of antibodies (HCV\u2010Ab) detection followed by HCV\u2010RNA or HCV core antigen (HCV\u2010Ag) confirmatory testing either on a second sample or by same sample reflex testing. The undiagnosed and unconfirmed rates were evaluated by assays false negative estimates and each algorithm patients\u2019 drop\u2010off. Age, liver disease stages distribution, liver disease stage costs, treatment effectiveness and costs were used to evaluate the quality\u2010adjusted life\u2010years (QALYs) and the incremental cost\u2010effectiveness ratios (ICER).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The reference option was Rapid HCV\u2010Ab followed by second sample HCV\u2010Ag testing which produced the lowest QALYs (866,835 QALYs). The highest gains in health (QALYs=974,458) was obtained by HCV\u2010RNA reflex testing which produced a high cost\u2010effective ICER (\u20ac891\/QALY). Reflex testing (same sample\u2010single visit) vs two patients\u2019 visits algorithms, yielded the highest QALYs and high cost\u2010effective ICERs (\u20ac566 and \u20ac635\/QALY for HCV\u2010Ag and HCV\u2010RNA, respectively), confirmed in 99.9% of the 5,000 probabilistic simulations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our data confirm, by a cost effectiveness point of view, the EASL and WHO clinical practice guidelines recommending HCV reflex testing as most cost effective diagnostic option vs other diagnostic pathways.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15070","type":"journal-article","created":{"date-parts":[[2021,9,28]],"date-time":"2021-09-28T21:18:19Z","timestamp":1632863899000},"page":"26-37","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Optimizing diagnostic algorithms to advance Hepatitis C elimination in Italy: A cost effectiveness evaluation"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3974-3798","authenticated-orcid":false,"given":"Andrea","family":"Marcellusi","sequence":"first","affiliation":[{"name":"Economic Evaluation and HTA (EEHTA) CEIS Faculty of Economics University of Rome \u201cTor Vergata\u201d Rome Italy"},{"name":"Institute of Leadership and Management in Health Kingston Business School Kingston University London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4738-5505","authenticated-orcid":false,"given":"Francesco Saverio","family":"Mennini","sequence":"additional","affiliation":[{"name":"Economic Evaluation and HTA (EEHTA) CEIS Faculty of Economics University of Rome \u201cTor Vergata\u201d Rome Italy"},{"name":"Institute of Leadership and Management in Health Kingston Business School Kingston University London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murad","family":"Ruf","sequence":"additional","affiliation":[{"name":"Public Health, Medical Affairs Gilead Science London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0804-0387","authenticated-orcid":false,"given":"Claudio","family":"Galli","sequence":"additional","affiliation":[{"name":"Global Medical and Scientific Affairs Core Laboratory, Abbott Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0941-3226","authenticated-orcid":false,"given":"Alessio","family":"Aghemo","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences Humanitas University Pieve Emanuele Italy"},{"name":"Division of Internal Medicine and Hepatology Humanitas Research Hospital IRCCS Rozzano Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8364-9152","authenticated-orcid":false,"given":"Maurizia R.","family":"Brunetto","sequence":"additional","affiliation":[{"name":"Internal Medicine Department of Clinical and Experimental Medicine University of Pisa Pisa Italy"},{"name":"Hepatology Unit and Laboratory of Molecular Genetics and Pathology of Hepatitis Viruses University Hospital of Pisa Pisa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7291-8687","authenticated-orcid":false,"given":"Sergio","family":"Babudieri","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Disease Unit Department of Medical Surgical and Experimental Sciences University of Sassari Sassari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4480-9544","authenticated-orcid":false,"given":"Antonio","family":"Craxi","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Unit Department of Internal Medicine and Medical Specialties \u201cPROMISE\u201d University of Palermo Palermo Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3205-9758","authenticated-orcid":false,"given":"Massimo","family":"Andreoni","sequence":"additional","affiliation":[{"name":"Department of Systems Medicine University of Rome \u201cTor Vergata\u201d Rome Italy"},{"name":"Infectious Diseases Clinic University Hospital \u201cTor Vergata\u201d Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2656-224X","authenticated-orcid":false,"given":"Loreta A.","family":"Kondili","sequence":"additional","affiliation":[{"name":"Center for Global Health Istituto Superiore di Sanit\u00e0 Rome Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,10,8]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"World Health Organization.Global Health Sector Strategy on Viral Hepatitis 2016\u20102021 [Internet].2016. 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