HCV screening among people who inject drugs is cost-effective, study finds
Screening people who inject drugs for hepatitis C virus may be a cost-effective way to combat HCV infection and could be preferable to universal testing when resources are limited, according to an analysis published in JAMA Network Open.
The intervention may also lower the risk for untreated HCV and liver-related mortality among patients.
“Clinicians should prioritize testing of people for hepatitis C virus infection, especially for people who inject drugs (PWID), even if people are seeking treatment for other health care problems and circumstances,” Moosa Tatar, MA, of the Matheson Center for Health Care Studies at the University of Utah, told Healio. “Clinicians should also increase awareness about HCV and its symptoms.”
Tatar and colleagues analyzed the cost-effectiveness of universal HCV screening for adults aged 18 years or older and targeted HCV screening among PWID. They used data from 10,000 participants to conduct a microsimulation, with the primary outcome being cost per quality-adjusted life-year (QALY).
Results showed that targeted screening among PWID increased QALY by 0.23 — about 3 months — with an incremental cost-effectiveness ratio of $45,465 per QALY. Universal screening increased QALY by 0.01 and had an incremental cost-effectiveness ratio of $291,277 per QALY. Screening among PWID increased total costs an estimated $10,457 per person, while universal screening and treatment increased costs by $2,845 per person, the researchers reported.
Although the CDC currently recommends universal HCV screening for adults aged 18 years or older, Tatar noted that targeted screening may still be useful in specific settings.
“Universal screening for hepatitis C virus is very important because the majority of infected people are not aware of their disease,” Tatar said. “However, when there are resource limitations, our study suggests that targeted screening of high-risk individuals is preferable and cost-effective.”
Tatar also emphasized that one of the study’s major limitations was the assumption that HCV reinfection among PWID was equal to that of the general population, when reinfection among PWID may be much higher.
“We only included direct medical costs in our model, and thus our analysis may be conservative,” Tatar concluded. “Future studies should examine the indirect costs related to hepatitis C virus treatment, such as patients’ mental health status, informal caregiving, etc.”
CDC. Testing recommendations for Hepatis C virus infection. https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm#:~:text=CDC%20Recommendations%20for%20Hepatitis%20C,is%20less%20than%200.1%25*. Accessed Sept. 14, 2020.