A Cost-Effective Method to Decrease HCV Infections in High-Risk Communities

Routine, rapid hepatitis C virus (HCV) testing during clinical visits appears to be cost-effective in settings in which there is a high prevalence of HCV and injection drug use, a new study has found.

At present, recommendations from the Centers for Disease Control and Prevention (CDC) advocate for routine, risk-based HCV testing for young adults who inject drugs, and one-time testing for those born between 1945 and 1965. However, given that CDC data suggests that the vast majority of HCV cases in the United States are linked with injection-drug use, it has been hypothesized that more routine testing in these at-risk populations could increase diagnosis and, therefore, proper treatment of the disease.

In a study published on September 9, 2017, in the journal Clinical Infectious Diseases, researchers from the Boston University School of Medicine and School of Public Health, assessed the “clinical benefit and cost-effectiveness” of routine HCV testing for youth in high-risk communities—or those with a high incidence of the disease. To do so, they developed a decision analytic model designed to estimate quality-adjusted life years (QALYs), lifetime costs (in US dollars, as of 2016), and incremental cost-effectiveness ratios (ICER) associated with 9 different approaches for patients between the ages of 15 and 30 seen at urban community health centers. The 9 approaches involved either targeted or routine testing, “rapid finger stick” or standard venipuncture, and/or physician-administered or counselor-initiated.

“Over the past few years, there has been an increase in HCV among young people who inject drugs,” study co-author Sabrina A. Assoumou, MD, MPH, Assistant Professor, Boston University School of Medicine, told Contagion^®. “This has been seen in urban as well as rural areas around the United States. This high rate of HCV among young adults was also noted in Massachusetts and some neighborhoods in Boston. Therefore, our research team collaborated with the Boston Public Health Commission to determine the best testing approach to identify young adults with HCV.”

Notably, Dr. Assoumou and her colleagues found that routine HCV testing increased lifetime medical costs per patient by only $80, while adding to .0013 discounted QALYs per patient, compared to the targeted risk-based testing approaches for people who inject drugs (PWID) currently recommended by the CDC. Overall, when compared with all other testing approaches, routine rapid testing added more QALYs at a reduced cost (per QALY).

In addition, they found that counselor-initiated routine, rapid HCV testing had an ICER of $71,000 per additional QALY, and that counselor-initiated testing was cost-effective (defined as ICER <$100,000 per QALY) in communities in which the prevalence of PWID was >.59%, HCV prevalence among PWID was >16%, and the HCV reinfection rate was >26 cases per 100 person-years. Deterministic and probabilistic sensitivity analyses revealed that routine rapid testing was the optimal strategy in 90% of all simulations performed.

“Our study specifically focused on young adults at high-risk for HCV, namely persons who inject drugs, who are seen in neighborhoods with a high reported rate of HCV,” Dr. Assoumou explained. “We are now looking at different testing approaches in other groups at risk [for HCV].”

In their concluding remarks, she and her colleagues note, “We show that routine testing provides the most clinical benefit and best value for money in an urban community health setting where HCV prevalence is high. Centers should consider either routine rapid testing by a counselor/tester or provide reflex HCV RNA following venipuncture testing. Future studies are needed to define the programmatic effectiveness of HCV treatment among youth, and testing and treatment acceptability in this population.”

Funding for this study was provided via grants from the National Institute on Drug Abuse and the National Institute of Allergy and Infectious Diseases.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.