Cost Effectiveness of Universal Screening for Hepatitis C Virus Infection in the Era of Direct-Acting, Pangenotypic Treatment Regimens  Mark H. Eckman, John W. Ward, Kenneth E. Sherman  Clinical Gastroenterology and Hepatology  Volume 17, Issue 5, Pages 930-939.e9 (April 2019) DOI: 10.1016/j.cgh.2018.08.080 Copyright © 2019 AGA Institute Terms and Conditions

Figure 1 One-way sensitivity analysis examining the ICER of universal screening compared with no screening, as a function of the prevalence of HCV-antibody positivity in the general population. K$/QALY, signifies thousands of dollars/quality-adjusted life year. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions

Figure 2 One-way sensitivity analysis examining the ICER of universal screening compared with birth cohort screening, as a function of the prevalence of HCV-antibody positivity in adults who are not members of the birth cohort born between 1945 and 1955. Above a prevalence of 0.07%, universal screening costs less than $50,000 per QALY compared with birth cohort screening. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions

Figure 3 One-way sensitivity analysis examining monthly cost of DAA agent. The base-case value for this parameter is $8090. Below a monthly cost of roughly $2500, universal screening dominates, being less costly and more effective than birth cohort screening. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions

Figure 4 Tornado diagram of 1-way sensitivity analyses for the strategy of universal screening compared with birth cohort screening. The ICER, in dollars per QALY (horizontal axis) ranges between minus $10,000 and $100,000/QALY. For each parameter, the upper and lower limits of the sensitivity analysis are based on either the 95% CIs, or a clinically reasonable range. A negative ICER indicates that the strategy is less expensive and more effective than its competitor. The base-case result is marked by the dotted line at the center of the tornado plot. Parameters at the top of the figure (wide mouth of the tornado) have a larger impact on the ICER within their 95% CIs or clinically plausible range. EIA, ELISA. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions

Supplementary Figure 1 (A) Decision tree model. (B) Markov model. AB, antibody; EIA, ELISA; PCR, polymerase chain reaction; RAS, resistance associated substitution; Rx, treatment; s/p, status post. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions

Supplementary Figure 2 State transitions for Metavir fibrosis stages. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions

Supplementary Figure 3 Seed distributions of Metavir fibrosis stages at beginning of Markov simulation. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions

Supplementary Figure 4 Natural history of chronic hepatitis C infection - health state transitions across lifetime. HCC, hepatocellular carcinoma; s/p, status post. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions

Supplementary Figure 5 Cumulative probability of complications of end-stage liver disease. HCC, hepatocellular carcinoma. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions

Supplementary Figure 6 Cost-effectiveness acceptability curve. Clinical Gastroenterology and Hepatology 2019 17, 930-939.e9DOI: (10.1016/j.cgh.2018.08.080) Copyright © 2019 AGA Institute Terms and Conditions