Young injection drug users with HCV benefit from a cost-effective method of viral testing.
Routine and rapid testing for the hepatitis C virus (HCV) during clinical visits may be cost-effective and improve life expectancy for young injection drug users, according to a new study.
Today almost all HCV transmission in the US occurs among youth who inject drugs (PWID), the Boston Medical Center researchers wrote. In collaboration with the Boston Public Health Commission, they sought to determine the best way to identify and test such individuals in high-risk communities or those with a high incidence of HCV.
The researchers created a simulation model to calculate quality-adjusted life years (QALYs), lifetime costs in 2016 US dollars and incremental cost-effectiveness ratios (ICER) for one-time testing among patients between 15 and 30 years old. The young adults were seen at urban community health centers.
Three different testing strategies were evaluated.
The first considered targeted versus routine testing. Targeted screening, a standard practice, pinpoints patients at high-risk for contracting HCV. These individuals include “baby boomers” — born from 1945 to 1965 — as well those diagnosed with HIV, children born to HCV-positive women and individuals who engage in injection drug use, study co-author Sabrina Assoumou, MD, MPH, an infectious diseases physician at Boston Medical Center, told MD Magazine.
“’Routine” screening, as defined in our study, tests all individuals in a community with a high prevalence of hepatitis C virus,” Assoumou said.
The researchers also investigated testing via rapid finger stick and compared it with venipuncture. Rapid testing provides results on the same day that the sample is drawn. Standard testing requires patients to return for a second appointment to get the results.
In addition, the team studied the outcomes when testing was prescribed by a physician and when it was ordered by a counselor.
“Using simulation modeling, we found that when standard testing was applied, patients were less likely to get their test results and therefore had limited access to treatment,” Assoumou said. “Rapid testing provided more clinical benefit than standard testing.”
Rapid testing also provided higher QALYs at a lower cost per QALY gained, and was always preferred, the researchers said.
Overall, the combination of routine, rapid testing proved cost effective and improved patients’ quality of life, the team concluded. Routine testing increased lifetime medical cost by $80 per person, according to the study.
Further, when tests were suggested by counselors, more HCV cases were identified and fewer deaths occurred than with targeted, standard testing by a physician. Counselor-initiated routine rapid testing was associated with an ICER of $71,000 per QALY gained, the researchers wrote.
“In communities with a high number of reported HCV cases among 15 to 30-year-olds, we showed that routine testing would enable the identification of cases that would have been missed if a history of injecting drugs had not been elicited or disclosed as part of the medical history,” Assoumou said.
Assoumou said she’s seen the benefits of routine, rapid testing in real-life situations.
“In the Boston area, we have sites that perform rapid testing and these locations have been more successful at arranging for linkage to care of newly diagnosed individuals,” Assoumou said.
For the next step of research, Assoumou said they are looking at different testing approaches in other at-risk groups.
A press release regarding the study was made available.
The study, "The cost-effectiveness of one-time hepatitis C screening strategies among adolescents and young adults in primary care settings," was published in Clinical Infectious Diseases last month.