La simplificación del proceso de diagnóstico de la hepatitis C crónica es una estrategia coste-efectiva

García, Féderico; Domínguez-Hernández, Raquel; Casado, Marta; Macı́as, Juan; Téllez, Francisco; Pascasio, J.M.; Alados, Juan Carlos

doi:10.1016/j.eimc.2019.03.001

Cited by 11 publications

(1 citation statement)

References 18 publications

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“…It is noteworthy that the reflex testing protocol provided a diagnosis within a mean of 2 days, in contrast with the six-step protocol, which lasted weeks-or even months-due to administrative barriers to scheduling extra appointments. In addition to a shorter time for diagnosis, previous studies have found that the application of similar protocols are cost-effective (16). In this regard, it is important to highlight that the cost of a viral RNA determination (less than 30 euros in our laboratory) is much lower than the cost of a physician appointment and a blood extraction, so overall cost reduction may be of note.…”

Section: Discussionmentioning

confidence: 90%

Significant Improvement in Diagnosis of Hepatitis C Virus Infection by a One-Step Strategy in a Central Laboratory: an Optimal Tool for Hepatitis C Elimination?

et al. 2019

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The remarkable effectivity of current antiviral therapies has led to consider the elimination of hepatitis C virus (HCV) infection. However, HCV infection is highly underdiagnosed; therefore, a global strategy for eliminating it requires improving the effectiveness of HCV diagnosis to identify hidden cases. In this study, we assessed the effectiveness of a protocol for HCV diagnosis based on viral load reflex testing of anti-HCV antibody-positive patients (known as one-step diagnosis) by analyzing all diagnostic tests performed by a central laboratory covering an area of 1.5 million inhabitants in Barcelona, Spain, before (83,786 cases) and after (45,935 cases) the implementation of the reflex testing protocol. After its implementation, the percentage of anti-HCV-positive patients with omitted HCV RNA determination remarkably decreased in most settings, particularly in drug treatment centers and primary care settings, where omitted HCV RNA analyses had absolute reductions of 76.4 and 20.2%, respectively. In these two settings, the percentage of HCV RNA-positive patients identified as a result of reflex testing accounted for 55 and 61% of all anti-HCV-positive patients. HCV RNA results were provided in a mean of 2 days. The presence of HCV RNA and age of ≥65 years were significantly associated with advanced fibrosis, assessed using the serological FIB-4 index (odds ratio [OR], 5.92; 95% confidence interval [CI], 3.4 to 10.4). The implementation of viral load reflex testing in a central laboratory is feasible and significantly increases the diagnostic effectiveness of HCV infections, while allowing the identification of underdiagnosed cases.

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Section: Discussionmentioning

confidence: 90%