Clinical impact and cost-effectiveness of hepatitis C testing in an emergency department in Barcelona, Spain

Llaneras, Jordi; Barreira, Ana Paula; Rando-Segura, Ariadna; Domínguez-Hernández, Raquel; Rodríguez-Frías, Francisco; Campins, Magda; Barciela, Mar Riveiro; Arranz, Maria; Esteban, Rafael; Buti, María

doi:10.1016/s0168-8278(22)00498-6

Cited by 6 publications

(5 citation statements)

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“…Esto sitúa a los SU en una posición ideal para la identificación de nuevos casos de hepatitis en personas que desconocen su infección. De hecho, algunos estudios recientes sobre programas de diagnóstico de virus transmitidos por la sangre (VTS) en los SU confirman que son una estrategia factible, eficaz y coste-efectiva 21,22 . Un estudio de cribado oportunista realizado en pacientes mayores de 18 años que acudían al SU de un hospital de Barcelona y que requirieran una analítica por cualquier motivo reveló una prevalencia de infección activa por VHC de un 0,7%, donde el 44% de los pacientes diagnosticados desconocían su infección y un 60% no tenía exposiciones de riesgo conocidas 22 .…”

Section: Introductionunclassified

Opportunistic screening for hepatitis C virus infection in an emergency department in Almeria, Spain

Camelo-Castillo,

Jordán Madrid,

Cabezas Fernández

et al. 2023

Emergencias

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Objetivo. Se estima que la prevalencia de infección activa por el virus de la hepatitis C (VHC) en España es de un 0,2%, pero un gran número de personas desconocen su estado de infección. Por ello, se requiere aumentar las estrategias de diagnóstico precoz dirigidas a población vulnerable y con escaso vínculo con el sistema sanitario. El objetivo es evaluar el impacto de un programa de cribado oportunista del VHC en los pacientes atendidos en el servicio de urgencias (SU) de un hospital universitario. Método. Se realizó un cribado oportunista entre agosto de 2021 y abril de 2023 a los pacientes de 18 a 69 años atendidos en el SU que no se habían realizado la prueba del VHC el año anterior, y que requerían un análisis de sangre dentro de la práctica clínica habitual por cualquier motivo. Resultados. Durante el periodo de estudio se atendieron 110.267 pacientes en el SU, fueron candidatos a realizar el cribado 22.712 (20,6%), y finalmente se realizó una serología frente al VHC a 11.368 pacientes (50,1%). Se identificaron 43 casos (0,4% de los test efectuados) de infección activa por VHC (viremia), de los cuales, 24 (56%) desconocían previamente su estado. La media de edad del total de pacientes virémicos fue de 57 (DE: 6 años), 34 (79,1%) eran hombres y 5 (11,6%) tenían nacionalidades distintas a la española. No se identificaron factores de riesgo relacionados con la infección por VHC en 22 (51,2%) de los pacientes, y 41 (95,3%) habían tenido oportunidades de diagnóstico en visitas previas al sistema de salud. De los 18 pacientes analizados mediante elastografía transitoria, 7 (38,8%) presentaban cirrosis en el momento del diagnóstico. Se logró vincular a la atención médica posterior a 33 (77%) de los pacientes con infección activa. Conclusiones. Las tasas de infección activa por VHC detectadas en el programa de cribado fueron más altas que la prevalencia estimada en la población general. El cribado oportunista de VHC en los SU puede ser de utilidad para aumentar el diagnóstico y debe ser considerado como una herramienta para la eliminación de la hepatitis C.

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Section: Introductionunclassified

Opportunistic screening for hepatitis C virus infection in an emergency department in Almeria, Spain

Camelo-Castillo,

Jordán Madrid,

Cabezas Fernández

et al. 2023

Emergencias

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“…Individuals with no history of HBV infection and no previous immunity are vaccinated, and infected individuals are evaluated for therapy. Another example is hospital emergency room screening, which has shown a higher prevalence of hepatitis B infection than in the general population and facilitates seamless linkage to care 20 . Again, important steps in this line are the generation of robust epidemiological data to guide HBV elimination strategies and a strong political commitment to provide specific funding.…”

Section: Potential Solutionsmentioning

confidence: 99%

HBV elimination in Europe: Current status and challenges

Buti,

Duffell

2024

Clinical Liver Disease

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In 2016, an estimated 3.6 million people were living with chronic HBV infection in the 30 countries of the European Union (EU) and European Economic Area (EEA). Together with HCV infection, HBV is responsible for ~55% of all deaths related to liver cancer and 45% of deaths due to cirrhosis and other chronic liver conditions. Notably, deaths from HCC continue to increase, with hepatitis-specific deaths in the EU exceeding those attributed to either tuberculosis or HIV. [1,2] The epidemiological status of HBV infection in EU/EEA countries exhibits marked geographical differences and varying burdens of disease among key affected groups, such as men who have sex with men, people who inject drugs (PWID), and some migrant populations. [3] The prevalence of HBV is low in most EU/EEA countries with the virus affecting <0.1% of the population, especially among countries in the North West part of the region where a high proportion of cases are reported among migrants from countries with a higher endemicity and incomplete vaccination programs. [3] Nonetheless, a recent systematic review of HBV prevalence across EU/EEA countries found studies with prevalence estimates up to 8% among key risk groups such as specific migrant populations (eg, refugees) and people in prison. However, prevalence among most population groups has actually decreased in line with changes in prevalence among the general population, which reflects the impact of highly effective vaccination programs.

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“…However, due to improved treatment efficacy and failings in risk-based strategies, this has been re-examined, and there are now cost-effectiveness justifications for universal testing in pregnancy [13][14][15][16]. Overseas data have shown that ED-based viral hepatitis testing is cost-effective [17][18][19] but Australian data are currently lacking.…”

Section: Introductionmentioning

confidence: 99%

“…is method could reach OB patients or other difficult-to-access groups. Routine testing in the ED has been demonstrated to be effective in detecting blood borne infections in several countries [19,21,22]. However without a mechanism to ensure that testing is performed in all eligible patients without interfering with ED care or relying on human factors, uptake rates are variable and are as low as 27% in one UK study [21].…”

Section: Introductionmentioning

confidence: 99%

Finding Cases of Hepatitis C for Treatment Using Automated Screening in the Emergency Department is Effective, but What Is the Cost?

Prince

Girolamo

Pipicella

et al. 2022

Canadian Journal of Gastroenterology and Hepatology

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Case detection remains a major challenge for hepatitis C virus (HCV) elimination. We have previously published results from a pilot of an emergency department (ED) semiautomated screening program, SEARCH; Screening Emergency Admissions at Risk of Chronic HCV. Several refinements to SEARCH have been developed to streamline and reduce cost. All direct costs of HCV testing until direct-acting antiviral (DAA) therapy initiation were calculated. Cost was assessed in 2018 Australian Dollars. A cost analysis of the initial program and refinements are presented. Sensitivity analysis to understand impact of variation in staff time, laboratory test cost, changes in HCV antibody (Ab) prevalence, RNA positivity percentage, and rate of linkage to care was conducted. Impact of refinements (SEARCH (2)) to cost is presented. The total SEARCH pilot, testing 5000 patients was estimated to cost $110,549.52 (range $92,109.79–$129,581.24) comprising of $68,278.67 for HCV Ab testing, $21,568.99 for follow-up and linkage to care of positive patients and $20,701.86 to prepare HCV RNA positive patients for treatment. Internal program refinements resulted in a 25% cost reduction. Following refinements, the cost of HCV antibody screening was $8.46 per test and the total cost per positive HCV Ab, positive HCV RNA, and per treated patient were $611.77, $2,168.64, and $3,566.11, respectively. Our sensitivity analysis indicates costs per HCV case found are modest so long as HCV Ab prevalence was at least 1%. ED screening is an affordable strategy for HCV case detection and elimination.

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Clinical impact and cost-effectiveness of hepatitis C testing in an emergency department in Barcelona, Spain

Cited by 6 publications

References 0 publications

Opportunistic screening for hepatitis C virus infection in an emergency department in Almeria, Spain

Opportunistic screening for hepatitis C virus infection in an emergency department in Almeria, Spain

HBV elimination in Europe: Current status and challenges

Finding Cases of Hepatitis C for Treatment Using Automated Screening in the Emergency Department is Effective, but What Is the Cost?

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