10 Jul Cost-Effectiveness of Routine Hepatitis C Testing

MedicalResearch.com Interview with:

Dr. Assoumou

Sabrina Annick Assoumou, MD, MPH
Assistant Professor, Medicine
Infectious Diseases at Boston Medical Center
Boston University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: During the opioid epidemic there has been an increase in the number of hepatitis C virus (HCV) infections due to transmission among persons who inject drugs (PWID). Federally qualified health centers (FQHC) provide care to an underserved and diverse patient population with a high proportion of both injection drug use and HCV. These health care facilities could provide opportunities to enhance HCV testing and treatment, especially at a time when recent data show that the United States is not on the list of high-income nations expected to achieve the World Health Organization’s goal of eliminating HCV by 2030.

MedicalResearch.com: What are the main findings? 

Response: As the Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force (USPSTF) have recently updated their recommendations to include one-time HCV testing screening for adults 18 years and older, we provide data on the cost-effectiveness of alternative testing approaches to expand testing and treatment in high prevalence clinical settings. We specifically evaluate the relative costs and comparative outcomes of various implementation models for HCV testing. We analyzed individual-level data from 57 FQHCs to model 9 strategies including permutations of HCV antibody testing modality (rapid vs. laboratory-based testing), person initiating testing (dedicated counselor/tester vs. clinician) and testing approach (risk-based targeted vs. expanded risk-based targeted with an intervention to increase testing vs. routine).

Using simulation modeling, we showed that routine rapid hepatitis C testing is cost-effective when compared to risk-based laboratory testing at US FQHC. Compared to risk-based laboratory testing, routine rapid testing performed by a counselor/tester identified 68% more cases in the first month and resulted in a 22% reduction in liver deaths among persons with liver cirrhosis. Our findings were most influenced by test results delivered to patients. 

MedicalResearch.com: What should readers take away from your report? 

Response: During the current period of high HCV incidence due to the opioid epidemic, routine testing should be considered at FQHC to identify HCV infections. In addition, facilities where point-of-care rapid testing may not be feasible should consider implementing interventions to improve test result delivery for individuals with laboratory-based testing.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Future research should evaluate outcomes of various implementation models including routine rapid HCV testing. 

Any disclosures? No disclosures.

Citation:

Hepatitis C Management at Federally Qualified Health Centers during the Opioid Epidemic: A Cost-Effectiveness Study
Assoumou, Sabrina A. et al. The American Journal of Medicine, Volume 0, Issue 0 

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Last Updated on July 10, 2020 by Marie Benz MD FAAD