In the Journals Plus

Testing all adults for HCV cost-effective, improves outcomes

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February 27, 2018

Newly published research suggests that expanding hepatitis C virus testing to everyone aged 18 years and older in the United States would likely be a cost-effective way to improve HCV outcomes.

The strategy would also identify more than a quarter million more HCV cases than the current CDC-recommended strategy of screening baby boomers — those born between 1945 and 1965 — investigators wrote in Clinical Infectious Diseases.

To estimate the cost-effectiveness of universal HCV screening, researcher Joshua A. Barocas, MD, an infectious disease physician at Massachusetts General Hospital and instructor of medicine at Harvard University Medical School, and colleagues used a simulation called the Hepatitis C Cost-Effectiveness (HEP-CE) model.

“When we expanded testing, the results were compelling,” Barocas said in a press release, referring to the simulation. “Changing the current recommendations could have a major public health impact, improving the quality of life for young people with HCV, and reducing death rates.”

HEP-CE simulates the course of the disease and its treatment in a hypothetical patient cohort with the same characteristics and epidemiology of the U.S. population, the researchers said. They applied the model to each of four HCV screening strategies:

  • standard of care: one-time testing of everyone born between 1945 and 1965;
  • 40 strategy: one-time testing of everyone aged 40 years or older;
  • 30 strategy: one-time testing of everyone aged 30 years or older; and
  • 18 strategy: one-time testing of everyone aged 18 years or older.

For all strategies, the researchers assumed risk-based testing of people who inject drugs. They found that each of the expanded testing strategies would identify more HCV cases, and result in the treatment and curing of more patients than standard of care. The greatest increases, however, were seen in the 18 strategy.

Compared with standard of care, the 18 strategy would result in 256,000 more HCV diagnoses and 280,000 more cases cured, the researchers estimated. Additionally, 18 had the lowest cost per quality adjusted life year, at $28,000.

Barocas and colleagues said their results could provide the basis for changes to the CDC’s HCV testing recommendations.

“In addition to risk-based testing, routine, one-time HCV testing of persons 18 years and older is cost-effective, could lead to improved clinical outcomes and is likely to identify more persons with HCV than the current birth cohort recommendations,” they wrote. “These findings should be considered for future recommendation revisions.” – by Joe Green

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Disclosures: The authors report no relevant financial disclosures.