Cost‐effectiveness of strategies for testing current hepatitis C virus infection

Abstract

Six strategies for identifying hepatitis C virus (HCV) viremia, involving testing for HCV antibody (HCVAb) followed by a nucleic acid test (NAT) for HCV RNA when the antibody test is positive, are compared. Decision analysis was used to determine mean relative cost per person tested and outcomes of HCV viremia detection. Parameters included proportions of test population with HCVAb and viremia plus specificity, sensitivity, and cost of individual tests. For testing a population with an HCVAb seroprevalence of 3.25%, all strategies when adopting quantitative NAT vary little in cost (range, $29.50-$30.70) and are highly viremia specific ( 0.9997). Four of the strategies using venipuncture blood for HCVAb testing (whether laboratory conducted or employing a rapid, point-of-care assay) and for NAT (whether done by reflex or using separately drawn blood) achieve the highest viremia sensitivities (range, 0.9950-0.9954). Point-of-care HCVAb testing in fingerstick blood followed by NAT in venipuncture blood yields relatively lower viremia sensitivity (0.9301). The strategy that requires returning for NAT is even less viremia sensitive (<0.9000) because of follow-up loss. Strategies adopting qualitative rather than quantitative NAT are slightly cheaper (range, $28.90-$29.99), similarly viremia specific ( 0.9997), but less viremia sensitive ( £ 0.9456). Viremia sensitivity and specificity remain the same regardless of the proportion of HCVAb-seropositive persons in the cohort being tested. Conclusions: Strategies involving HCVAb testing in venipuncture blood, whether laboratory conducted or using a point-of-care assay, when followed by quantitative NAT done reflexively or in separately drawn blood, are comparably economical and suitably viremia sensitive. Less cost-effective is point-of-care HCVAb testing in fingerstick blood followed by NAT in venipuncture blood. Least cost-effective is the strategy requiring the tested person to return for NAT. (HEPATOLOGY 2015;62:1396-1404

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

“…Reflex RNA testing for HCV antibody positive samples has been proposed as a strategy to further bridge this gap in the care cascade, and is currently being piloted in BC. Reflex genotyping has been shown to be cost effective and improve progression to genotyping in other settings.…”

CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020

“…There are statistical challenges with determining a "number needed to screen" to detect a relatively rare disease in lower-risk settings; therefore, providers and program directors are encouraged to consult their state or local health departments or CDC to determine a reasonable estimate of baseline prevalence in their setting or a methodology for determining how many persons they need to screen before confidently establishing that the prevalence is <0.1%. As a general guide: as HCV RNA prevalence is predicated on first testing for anti-HCV, and according to the most current serologic data in the United States, approximately 59% of anti-HCV positive persons are HCV RNA positive (2), an estimated 507 randomly selected patients in a setting of any size would need to be tested using any of the available anti-HCV tests (94) to detect an anti-HCV prevalence positivity of ≤0.17%, corresponding to an expected HCV RNA positivity prevalence of 0.1% with 95% confidence and 5% tolerance (95) (https://epitools.ausvet.com.au).…”

Systematic review: economic evaluations of HCV screening in the direct‐acting antivirals era

“…Four studies assessed different types of test or screening programs without including the treatment options available for the HCV and the health improvement associated to virus eradication . These studies’ characteristics are reported in the Table S1, but they are not described in details in this review.…”