HCV screening in all adults is cost-effective, improves outcomes

Compared with current recommendations, one-time screening of all adults for hepatitis C (HCV) is a cost-effective way to improve clinical outcomes and identify more infected individuals, according to a study accepted for publication in Clinical Infectious Diseases.

“When we expanded testing, the results were compelling,” said lead author Joshua Barocas, MD, infectious disease physician, Massachusetts General Hospital, and instructor in medicine, Harvard Medical School, Boston, MA. “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.”

Currently, the Centers for Disease Control and Prevention recommends HCV testing for only the highest risk population, people born between 1945 and 1965 and others at high risk, including intravenous drug users. A higher incidence of HCV in other groups, however, has been documented by recent trends.

Dr. Barocas and colleagues created simulations to estimate the efficacy of HCV testing strategies among different age groups. They compared the effects of current testing recommendations (testing in only people over 40 years old) with testing those over 30 years old and all adults over 18 years of age.

Using data from national databases, clinical trials, and observational cohorts, they found that all of the age-based strategies decreased the costs incurred by chronic HCV and advanced liver disease. The strategy of testing all adults, however, was the most effective.

Screening all adults would identify an additional 256,000 people infected with HCV, which could increase cure rates from 41% to 61% and reduce deaths due to HCV-related diseases by more than 20% compared with current recommendations. The greatest increases were seen in testing people aged 18 years of age and older.

Compared with the standard of care, this strategy would result in an estimated 280,000 additional cures at the lowest cost per quality-adjusted life year (QALY) gained (ICER: $28,000/QALY).

“Testing all adults would lead to earlier diagnosis and treatment for many people, which would help to prevent cirrhosis and other long-term complications,” said co-senior author Joshua Salomon, PhD, professor of medicine, Stanford University, Stanford, CA. “Overall, when you consider both the better health outcomes and the reduced costs of managing long-term liver disease, expanded testing offers excellent value for money.”

In the future, these findings should be considered for guideline revisions, noted the authors.

“Due in part to the opioid epidemic and the increase in injection drug use, the country has seen an increase in cases of HCV among young people,” said co-senior author Benjamin Linas, MD, infectious disease physician, Boston Medical Center, and associate professor of medicine, Boston University Medical Center, Boston, MA. “The CDC could address this public health concern by recommending all adults receive a one-time HCV test.”

This study was funded by the National Institute on Drug Abuse at the National Institutes of Health, the MGH Fund of Medical Delivery, and the US Centers for Disease Control and Prevention.