Hepatitis C Virus Diagnostics: The Road to Simplification

Feld, Jordan J.

doi:10.1002/cld.760

Cited by 22 publications

(48 citation statements)

References 10 publications

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“…A substantial loss of patients between each step has been observed, thus pointing to challenges and barriers towards an efficient HCV care. Depending on countries, 27–56% of all infected patients reached the stage of a confirmed infection, and only 12–16% were finally referred to treatment [9, 11, 18, 34]. Against these challenges, some research has been made on how to increase engagement in HCV care to ensure that barriers are reduced.…”

Section: Discussionmentioning

confidence: 99%

“…Against these challenges, some research has been made on how to increase engagement in HCV care to ensure that barriers are reduced. Several studies evaluated the effectiveness of different interventions to increase uptake of testing in different populations, or pointed to the need for optimizing the screening cascade [11, 34–36]. As well as all other interventions in health care, proposed new strategies in screening need undergo a framework of evidence generation with cost-effectiveness evaluations being an essential element [37].…”

Section: Discussionmentioning

confidence: 99%

“…Screening activities must reach the higher proportion of undiagnosed people to have a major population-based impact [9]. Therefore, continuous efforts towards more effective screening strategies including a higher testing rate are required [6, 7, 10, 11]. Testing guidelines indicate the need to screen individuals for antibodies to HCV (AB) and to confirm the presence of viral replication [8, 12, 13].…”

Section: Introductionmentioning

confidence: 99%

“…The latter, though less sensitive than current NAT methods, bears several operative advantages and guarantees an almost equivalent clinical sensitivity and has been recently emerged as a suitable alternative to RNA testing [6, 14–18]. Most approaches include several steps in the diagnostic process that often lead to incomplete diagnosis with a positive anti-HCV result not followed by confirmatory tests, that is an almost universal gap in HCV screening [11, 19]. According to the official guideline for hepatitis C screening in Russia [20], people are referred to a laboratory for initial screening with AB.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the number of complete diagnosis and the effectiveness of screening massively relies on people’s adherence to medical referrals. Since a loss to follow-up occurs at each step of the process, the need to consolidate the screening cascade has become apparent [11, 19, 21]. Suggested simplified algorithms, and even a one-step diagnostic procedure, have been proposed [17, 22], but in most instances a sound health economic evaluation is lacking, since studies are usually focused on direct costs only [15, 18].…”

Section: Introductionmentioning

confidence: 99%

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Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis

et al. 2019

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Objective Screening for hepatitis C in Russia is a complex process that involves several visits and stepwise testing, limiting adherence and substantially reducing the yield in the identification of active infections. We aimed to evaluate the cost-effectiveness of different screening algorithms from a health system perspective. Methods A decision analytic model was applied to a hypothetical adult population eligible to participate in a general screening program for hepatitis C in Russia. The standard pathway (I: Screen for anti-HCV antibodies followed by a nucleic acid test for HCV RNA on antibody positives) was compared to three alternatives (II: Screen for antibodies, a reflexed test for HCV antigen on antibody positives, and RNA on antigen negatives; III: Screen for antibodies, a reflexed test for HCV antigen on antibody positives; IV: Screen for antigen). Each strategy considered a cascade of events (referral, adherence, testing, diagnosis) that must occur for screening to be effective. The primary measure of effectiveness was the number of diagnosed active infections. Calculations followed a health system perspective with costs derived from 2017 reimbursement rates and a willingness-to-pay of 2,000RUB ($82) per diagnosed active infection. Model was tested with deterministic and probabilistic sensitivity analyses. Results Non-adherence to screening stages reduced the capture rate of active infections in Strategy I from 79.0% to 40.6%. Strategies II, III, and IV were less affected and identified 69%, 67%, and 104% more infections. Average costs per diagnosed infection were decreased by 41% from 89,599RUB ($3,681) for I to 53,072RUB ($2,180), 53,004RUB ($2,177), and 59,633RUB ($2,450) for II, III, and IV, respectively. With a probability of 97%, Strategy III was most cost-effective with an incremental cost-effectiveness ratio vs. I of -1,373RUB (CI: -5,011RUB to -2,033RUB; $-56; CI: -$206 to -$84). Below a willingness-to-pay of 91,000RUB ($3,738), Strategy IV was not cost-effective. Sensitivity analyses confirmed the robustness of results. Conclusions Testing strategies for hepatitis C with HCV antigen on HCV antibody positive cases offer a streamlining opportunity for population screening programs. Those shall increase the chances for detecting active infections and are cost-effective over current practice in Russia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis

et al. 2019

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Non‐targeted hepatitis C virus screening in acute care healthcare settings in the Southern Appalachian region

et al. 2022

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Objectives The objective of this study was to evaluate the performance of non‐targeted hepatitis C virus (HCV) screening in emergency departments (EDs) and other healthcare settings in terms of patients identified with HCV infection and linked to HCV care. Methods In the Southern Appalachian region of the United States, we developed non‐targeted HCV screening and linkage‐to‐care programs in 10 institutions at different healthcare settings, including EDs, outpatient clinics, and inpatient units. Serum samples were tested for HCV antibodies, and if positive, reflexed to HCV ribonucleic acid (RNA) testing as a confirmatory test for active infection. Patients with positive RNA tests were contacted to link them to HCV care. Results Between 2017 and 2019, among 195,152 patients screened for HCV infection, 16,529 (8.5%) were positive by antibody testing, 10,139 (5.2% of screened patients and 61.3% of patients positive by antibody test) were positive by RNA testing, and 5778 (3.0% of screened patients and 57.0% of patients positive by RNA test) were successfully linked to HCV care. Among 83,645 patients screened in EDs, 9060 (10.8%) were positive by HCV antibody, and 5243 (6.3%) were positive by RNA test. Among patients positive by RNA testing, linkage to care was lower for patients screened in the ED (44.1%) compared with outpatient clinics (67.6%) ( P < 0.01) and inpatient units (50.9%) ( P < 0.01). Conclusions Non‐targeted HCV screening in acute care settings can identify large numbers of people with HCV infection. To optimize the utility of these screening programs, future work is needed to develop best practices that consistently link these patients to HCV care.

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Coordination, Cost, and Changing Epidemiology—Considerations in the Hepatitis C Care Cascade

Yang

Muir

2021

Hepatol. Commun.

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Hepatitis C Virus Diagnostics: The Road to Simplification

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/12-5-reading-feld a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/12-5-interview-feld the interview with the author

Cited by 22 publications

References 10 publications

Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis

Streamlining the screening cascade for active Hepatitis C in Russia: A cost-effectiveness analysis

Non‐targeted hepatitis C virus screening in acute care healthcare settings in the Southern Appalachian region

Coordination, Cost, and Changing Epidemiology—Considerations in the Hepatitis C Care Cascade

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