HIQA launches public consultation on a birth cohort testing programme for diagnosis of Hepatitis C

Date of publication:

The Health Information and Quality Authority (HIQA) has commenced a public consultation on a draft Health Technology Assessment (HTA) of offering once-off testing for the Hepatitis C virus (HCV) to people in Ireland born between 1965 and 1985.

HIQA undertook the HTA following the publication of the National Clinical Guideline for Hepatitis C Screening, which conditionally recommended offering birth cohort testing subject to the outcome of a full HTA to assess its clinical effectiveness, cost-effectiveness and budget impact.

Chronic HCV infection causes damage to the liver and other organs. It is often called the ‘silent disease’ as many people do not have symptoms. Unless treated, it can cause substantial morbidity and mortality over time, for example, 128 liver transplants completed in Ireland between 2005 and 2018 were due to HCV. However, this does not need to be the case, as highly effective and acceptable treatments for HCV are now available.
Dr Máirín Ryan, HIQA’s Deputy CEO and Director of Health Technology Assessment, said: “In Ireland, the prevalence of HCV infection is highest amongst those born between 1965 and 1985. Our analysis found that a one-time birth cohort testing programme for this group represents good value for money, but has significant upfront costs.”

Dr Ryan continued: “Around the world, targets are being set to eliminate viral hepatitis as a public health threat. Here in Ireland, the Health Service Executive aims to achieve the WHO target of making Hepatitis C a rare disease before 2030. Introduction of a birth cohort testing programme would improve Ireland’s chance of reaching this elimination goal.”

HIQA wants to hear the views of the Irish public on this draft report before it is finalised and invites members of the public to give feedback on the HTA until Tuesday, 27 April 2021.

Following this consultation, the final report will be subject to approval by the Board of HIQA and provided as advice to the Minister for Health to inform a decision on whether or not to provide birth cohort testing for HCV in Ireland.

You can read the draft report and take part in the public consultation on www.hiqa.ie.

For further information please contact:
Marty Whelan, Head of Communications and Stakeholder Engagement
01 814 7480 / 085 805 5202 / mwhelan@hiqa.ie

Notes to the Editor:

  • HIQA is the statutory organisation in Ireland with responsibility to carry out national health technology assessments (HTAs) and to develop guidelines for the conduct of HTAs across our healthcare system.
  • HIQA has a statutory remit to evaluate the clinical and cost-effectiveness of health technologies, providing advice to the Minister for Health and to the Health Service Executive (HSE).
  • The hepatitis C virus (HCV) has been a notifiable disease in Ireland since 2004. From 2004 to 2018, a total of 15,266 HCV cases were notified to the HPSC. It is estimated that there are approximately 12,000 people with undiagnosed chronic HCV infection in the 1965-1985 birth cohort.
  • HCV spreads from person-to-person through blood or body fluids. A major risk factor for HCV is intravenous drug use, but infection can be caused by needle stick injuries, blood transfusion, sex with someone infected, and it can be passed from mother to child.
  • Diagnosis of chronic HCV infection involves two steps:
    1. detection of anti-HCV antibody to indicate if a person has ever had acute HCV infection
    2. a supplementary nucleic acid amplification test or core antigen test to determine active infection.
  • Direct-acting antiviral (DAAs) have been shown to be safe and well-tolerated in treating chronic active HCV infection. The treatment course is typically for 8-12 weeks and is curative in 95% of cases.
  • An economic model was developed to estimate the costs and consequences of implementing a birth cohort testing programme over a lifetime time horizon. A systematic birth cohort testing programme, staggered over a four-year period, was found to be cost-effective at a willingness to pay (WTP) threshold of €20,000 per quality adjusted life-year (QALY). The economic model found that the upfront cost of testing and treating was balanced by the long-term benefits from prevention of advanced HCV disease and its associated costs.
  • Compared with no birth cohort testing, the incremental budget impact of introducing a systematic birth cohort testing programme was estimated at €65 million over a five-year time horizon.
  • The HTA was supported by an expert advisory group with representation from patient representatives, clinicians with relevant expertise, the Department of Health, the HSE, the Health Protection Surveillance Centre and methodology experts.