VirA+EmiC project: Evaluating real‐world effectiveness and sustainability of integrated routine opportunistic hepatitis B and C testing in a large urban emergency department

Nebbia, Gaia; Ruf, Murad; Hunter, Laura; Balasegaram, Sooria; Wong, Terry; Kulasegaram, Ranjababu; Surey, Julian; Khan, Zana; Williams, Jack; Karo, Basel; Snell, Luke B; Flower, Barnaby; Evans, Hannah; Douthwaite, Sam

doi:10.1111/jvh.13676

Cited by 11 publications

(12 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The analysis evaluated the cost-effectiveness of ED testing in two locations; Leeds Teaching Hospitals NHS Trust (LTHT), and Guys and St. Thomas' NHS Foundation Trust (GSTT) in London [13,14]. In both EDs, the electronic patient record systems were modified to include a HBV and HCV test for adults, unless they opt-out.…”

Section: Model Analyses and Decision Problemmentioning

confidence: 99%

Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom

Williams

Vickerman

Smout³

et al. 2022

Cost Eff Resour Alloc

Self Cite

View full text Add to dashboard Cite

Background Numerous studies have shown the effectiveness of testing for hepatitis B (HBV) and hepatitis C (HCV) in emergency departments (ED), due to the elevated prevalence amongst attendees. The aim of this study was to conduct a cost-effectiveness analysis of universal opt-out HBV and HCV testing in EDs based on 2 long-term studies of the real-world effectiveness of testing in 2 large ED’s in the UK. Methods A Markov model was used to evaluate ED-based HBV and HCV testing versus no ED testing, in addition to current testing practice. The two EDs had a HBV HBsAg prevalence of 0.5–0.9% and an HCV RNA prevalence of 0.9–1.0%. The analysis was performed from a UK health service perspective, over a lifetime time horizon. Costs are reported in British pounds (GBP), and outcomes as quality adjusted life years (QALYs), with both discounted at 3.5% per year. Incremental cost-effectiveness ratios (ICER) are calculated as costs per QALY gained. A willingness-to-pay threshold of £20,000/QALY was used. The cost-effectiveness was estimated for both infections, in both ED’s. Results HBV and HCV testing were highly cost-effective in both settings, with ICERs ranging from £7,177 to £12,387 per QALY gained. In probabilistic analyses, HBV testing was 89–94% likely to be cost-effective at the threshold, while HCV testing was 94–100% likely to be cost-effective, across both settings. In deterministic sensitivity analyses, testing remained cost-effective in both locations at ≥ 0.25% HBsAg prevalence, and ≥ 0.49% HCV RNA prevalence. This is much lower than the prevalence observed in the two EDs included in this study. Conclusions HBV and HCV testing in urban EDs is highly cost-effective in the UK, and can be cost-effective at relatively low prevalence. These results should be reflected in UK and European hepatitis testing guidelines.

show abstract

Section: Model Analyses and Decision Problemmentioning

confidence: 99%

Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom

Williams

Vickerman

Smout³

et al. 2022

Cost Eff Resour Alloc

Self Cite

View full text Add to dashboard Cite

show abstract

“…The analysis evaluated the cost-effectiveness of ED testing in two locations; Leeds Teaching Hospitals NHS Trust (LTHT), and Guys and St. Thomas' NHS Foundation Trust (GSTT) in London [13,14]. In both EDs, the electronic patient record systems were modi ed to include a HBV and HCV test for adults receiving a blood test as part of their care, unless they opt-out.…”

Section: Model Analyses and Decision Problemmentioning

confidence: 99%

“…Patients requiring linkage to care in both EDs were contacted by various means, including phone calls, text messages, and letters to their home and registered GP. Full details are available in the original testing publications [13,14]. Specialist outreach nurses or teams working with the homeless were also informed of those requiring linkage to care.…”

Section: Model Populationmentioning

confidence: 99%

“…A budget impact analysis was performed to estimate the costs associated with HBV and HCV testing and linkage to care. The analysis assumes testing is performed for one year (at the same testing rate as the two studies) [13,14]. For both HBV and HCV, the budget impact estimated the costs of the intervention, including all tests, contacting positive patients, and healthcare visits for those engaging with care (Table 2).…”

Section: Budget Impact Analysismentioning

confidence: 99%

“…We have used data from two long-term testing studies in two different cities in the UK, with a higher uptake of testing compared to the previous studies. This is likely to be re ective of the impact of real-world universal opt-out ED testing using electronic patient record based testing [13,14]. We also provide a budget impact analysis for decision makers who are considering the cost of implementing ED based testing.…”

Section: Comparisons With Other Researchmentioning

confidence: 99%

See 2 more Smart Citations

Universal testing for hepatitis B and hepatitis C in the Emergency Department: A cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom

Williams

Vickerman

Smout³

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background Numerous studies have shown the effectiveness of testing for hepatitis B (HBV) and hepatitis C (HCV) in emergency departments (ED), due to the elevated prevalence amongst attendees. The aim of this study was to conduct a cost-effectiveness analysis of universal opt-out HBV and HCV testing in EDs based on two long-term studies of the real-world effectiveness of testing in two large ED’s in the UK. MethodsA Markov model was used to evaluate ED-based HBV and HCV testing versus no ED testing, in addition to current testing practice. The two EDs had a HBV HBsAg prevalence of 0.5%-0.9% and an HCV RNA prevalence of 0.9%-1.0%. The analysis was performed from a UK health service perspective, over a lifetime time horizon. Costs are reported in British pounds (GBP), and outcomes as quality adjusted life years (QALYs), with both discounted at 3.5% per year. Incremental cost-effectiveness ratios (ICER) are calculated as costs per QALY gained. A willingness-to-pay threshold of £20,000/QALY was used. The cost-effectiveness was estimated for both infections, in both ED’s. Results HBV and HCV testing were highly cost-effective in both settings, with ICERs ranging from £7,177 to £12,387 per QALY gained. In probabilistic analyses, HBV testing was 89% to 94% likely to be cost-effective at the threshold, while HCV testing was 94% to 100% likely to be cost-effective, across both settings. In deterministic sensitivity analyses, testing remained cost-effective in both locations at ≥0.25% HBsAg prevalence, and ≥0.49% HCV RNA prevalence. This is much lower than the prevalence observed in the two EDs included in this study.Conclusions HBV and HCV testing in urban EDs is highly cost-effective in the UK, and can be cost-effective at relatively low prevalence. These results should be reflected in UK and European hepatitis testing guidelines.

show abstract

Prevalence, characteristics and challenges of late HIV diagnosis in Germany: an expert narrative review

Boesecke

Schellberg²,

Schneider

et al. 2023

Infection

View full text Add to dashboard Cite

Purpose We aimed to review the landscape of late HIV diagnosis in Germany and discuss persisting and emerging barriers to earlier diagnosis alongside potential solutions. Methods We searched PubMed for studies informing the prevalence, trends, and factors associated with late HIV diagnosis in Germany. Author opinions were considered alongside relevant data. Results In Germany, older individuals, heterosexuals, and migrants living with HIV are more likely to be diagnosed late. The rate of late diagnosis in men who have sex with men (MSM), however, continues to decrease. Indicator conditions less often prompt HIV testing in women and non-MSM. During the COVID-19 pandemic, the absolute number of late diagnoses fell in Germany, but the overall proportion increased, probably reflecting lower HIV testing rates. The Ukraine war and subsequent influx of Ukrainians living with HIV may have substantially increased undiagnosed HIV cases in Germany. Improved indicator testing (based on unbiased assessments of patient risk) and universal testing could help reduce late diagnoses. In patients who receive a late HIV diagnosis, rapid treatment initiation with robust ART regimens, and management and prevention of opportunistic infections, are recommended owing to severely compromised immunity and increased risks of morbidity and mortality. Conclusion Joint efforts are needed to ensure that UNAIDS 95-95-95 2030 goals are met in Germany. These include greater political will, increased funding of education and testing campaigns (from government institutions and the pharmaceutical industry), continued education about HIV testing by HIV experts, and broad testing support for physicians not routinely involved in HIV care.

show abstract

VirA+EmiC project: Evaluating real‐world effectiveness and sustainability of integrated routine opportunistic hepatitis B and C testing in a large urban emergency department

Cited by 11 publications

References 20 publications

Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom

Universal testing for hepatitis B and hepatitis C in the emergency department: a cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom

Universal testing for hepatitis B and hepatitis C in the Emergency Department: A cost-effectiveness and budget impact analysis of two urban hospitals in the United Kingdom

Prevalence, characteristics and challenges of late HIV diagnosis in Germany: an expert narrative review

Contact Info

Product

Resources

About