Study shows expanding hepatitis C testing to all adults is cost-effective and improves health outcomes

Screening all adults for hepatitis C virus infection (HCV) is a cost-effective way to improve clinical outcomes of HCV and identify more infected people compared to current recommendations, according to a new study by SHP’s Joshua Salomon and colleagues.

Using a simulation model, Salomon, a professor of medicine and core faculty member at Stanford Health Policy, and researchers from Boston Medical Center (BMC) and Massachusetts General Hospital (MGH) found that this expanded screening would increase life expectancy and quality of life while remaining cost-effective.

The infectious disease primarily attacks the liver. It is believed that one-in-30 Baby Boomers — born between 1945 and 1965 — have HCV, but don’t even know it because it can take years before symptoms emerge. The Centers for Disease Control and Prevention currently recommends HCV testing for boomers, but testing rates in this group remain relatively low, and recent trends show a higher incidence rate of HCV among young people.

“Testing all adults would lead to earlier diagnosis and treatment for many people, which would help to prevent cirrhosis and other long-term complications,” says Salomon, co-senior author of the study published in Clinical Infectious Diseases. “Overall, when you consider both the better health outcomes and the reduced costs of managing long-term liver disease, expanded testing offers excellent value for money.”

To address the potential benefits of changing the testing recommendations, the researchers created simulations to estimate the effectiveness of HCV testing strategies among different age groups. They compared effects of the current testing recommendations; of testing people over 40 years old or over 30 years old, and of testing all adults over 18 years old. All strategies included the current recommendations for targeted testing of high-risk individuals, such as people who inject drugs.

The study found that screening all adults would identify more than 250,000 additional people with HCV, increase cure rates from 41 to 61 percent, and reduce death rates for HCV-attributable diseases more than 20 percent, compared with current recommendations.

“When we expanded testing, the results were compelling,” says Joshua Barocas, lead author on the study and an infectious disease physician at MGH and an instructor in medicine at Harvard Medical School. “Changing the current recommendations could have a major public health impact, improving the quality of life for young people with HCV, and reducing death rates.”

The research team used data from national databases, clinical trials, and observational cohorts to inform their simulation models, which captured the details and dynamics of U.S. population demographics and HCV epidemiology.

All of the age-based strategies decreased costs related to managing chronic HCV and advanced liver disease, but the strategy of testing all adults was most effective. Even in a simulated scenario that required twice as much testing among uninfected people to identify the same number of HCV cases, the testing-all-adults strategy remained cost-effective.

Researchers say these findings should be considered by the CDC for future recommendations on HCV testing.

“Due in part to the opioid epidemic and the increase in injection drug use, the country has seen an increase in cases of HCV among young people,” says Benjamin Linas, MD, co-senior author of the study and infectious disease physician at BMC and an associate professor of medicine at Boston University Medical Center. “The CDC could address this public health concern by recommending all adults receive a one-time HCV test.”

The study was published online in Clinical Infectious Diseases and was funded by the National Institute on Drug Abuse at the National Institutes of Health, the MGH Fund of Medical Delivery and the U.S. Centers for Disease Control and Prevention.