Screening all adults for hepatitis C is a cost-effective way to improve clinical outcomes and identify more infected people compared to current recommendations, according to a new study.
Using a simulation model, researchers from Boston Medical Center, Massachusetts General Hospital and Stanford University found that this expanded screening would increase life expectancy and quality of life, while also remaining cost-effective.
Improving outcomes is a top priority for many hospitals since the healthcare system started transitioning from a fee-for-service model to a value-based model. While not all organizations have yet made the switch to a more value-based framework, current federal law is increasingly tying reimbursement to clinical quality. That means hospitals and health systems have to start thinking of patients as consumers, who vote for their favorite providers with their wallets.
The same holds true for hepatitis C virus patients. The Centers for Disease Control and Prevention currently recommends HCV testing for people born between 1945 and 1965, the highest-risk population in the U.S. But recent trends have shown a higher incidence rate of HCV among young people.
To address this gap in testing, the researchers created simulations to estimate the effectiveness of HCV testing strategies among different age groups. They compared effects of the current recommendations on testing of 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.
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 said these findings should be considered by the CDC for future recommendations on HCV testing.