Universal screening for HCV infection is cost-effective

One-time universal screening of all adults for chronic hepatitis C virus (HCV) infection is now cost-effective, according to a new study.

A growing number of younger patients are testing positive for HCV, fueled largely by the opioid crisis impacting communities around the country. Current guideline-based strategy suggests one-time screening of baby boomers, the 73 million U.S. adults born between 1945 and 1965. But the large increase in HCV infections, along with more effective, tolerable drug regimens for HCV, have led researchers to suggest earlier diagnosis and treatment of hepatitis C infection to prevent development of progressive liver disease and reduce the long-term risks of cirrhosis, liver cancer and other HCV-associated health problems.

Researchers led by Mark Eckman, MD, professor of clinical medicine at the University of Cincinnati, estimated the impact of one-time universal screening of adults 18 years of age and older compared either with no screening at all or birth cohort-based screening alone.

They measured effectiveness with quality-adjusted life years (QALY) and costs with 2017 U.S. dollars. Based on the model, one-time universal screening of U.S. residents would cost less than $50,000/QALY compared with a strategy of no screening.

“Most health economists consider anything less than $50,000 per QALY to be highly cost-effective,” said Eckman.

The researchers published their results online September 8 in Clinical Gastroenterology and Hepatology.

Compared with one-time birth cohort screening, one-time universal screening and treatment cost $11,378/QALY gained. Universal screening was cost-effective compared with birth cohort screening when the prevalence of HCV antibody positivity was greater than 0.07% among adults not in the cohort born from 1945 through 1965.

The face and treatment of hepatitis C has changed, making it reasonable to screen a wider population for HCV. “The incidence of hepatitis C among younger drug-injecting patients is skyrocketing so we have a blip in HCV cases that's no longer isolated to the baby boomer cohort,” Eckman said. “We are also now in an era of HCV treatments that is more effective than even five or six years ago. Furthermore, these new regimens are easier to tolerate, have fewer severe side effects and require a short period of treatment.”

“All these factors coming together are what drove the model to show that screening a broader population than just the baby boomer cohort is effective,” he added.

The baby boomer generation came of age during a time of drug experimentation. Many who may have tried injectable drugs never thought they had a problem, but may be infected with HCV. “While these silent cases have been hanging out for decades what has changed recently is the new epidemic of hepatitis C in younger patients related to drug use,” said Eckman.

The costs to treat HCV range from $9,000 to $30,000 per month, depending on the medications being used. Many health insurance plans, including Medicare Part D and most Medicaid plans, cover the costs of treatment.

The U.S. Preventive Services Task Force is currently reviewing and updating guidelines for HCV and may broaden the current screening recommendations.