Study: Opioid-Fueled Rise in Hepatitis C Incidence Calls for Universal Screening

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

The CDC estimates 2.7 million individuals in the United States have chronic HCV infection, with 81% of that group consisting of baby boomers—individuals born from 1945 through 1965. However, the opioid crisis in the United States has led to a growing incidence of HCV among young adults. Previous research from the CDC found that HCV cases rose 133% from 2004 to 2014, while admissions to substance use disorder treatment facilities for opioid injections climbed 93%.

For the study, which was published in Clinical Gastroenterology and Hepatology, the researchers developed a computerized Markov state transition model to estimate the effects of universal, 1-time HCV screening of adults 18 years of age or older in the United States. They compared this screening approach with the current guideline-based strategy of screening baby boomers or no screening at all. The researchers measured efficacy with quality-adjusted life years (QALYs) and cost from the health system perspective.

Based on the model, the researchers determined that universal 1-time screening of US adults with general population prevalence of HCV antibodies greater than 0.07% cost less than $50,000/QALY compared with a strategy of no screening. Compared with 1-time screening for the baby boomer cohort, universal 1-time screening and treatment cost $11,378/QALY gained, according to the study.

“Most health economists consider anything less than $50,000 per quality-adjusted life year to be highly cost-effective,” Mark Eckman, MD, professor of clinical medicine and director of University of Cincinnati Division of General Internal Medicine, said in a press release.

The rise in HCV infection among drug-injecting young adults represents a new population of those at risk for the disease, deviating away from the baby boomer cohort. With the introduction of new, more effective treatment regimens, the researchers noted that broadening screening methods can be a cost-effective strategy for controlling HCV incidence.

A recent systematic review published in The Lancet Gastroenterology and Hepatology provided evidence supporting the efficacy of HCV treatments in individuals who inject drugs. However, injection drug users with HCV face challenges to therapy access in many countries due to restrictions on treatment reimbursement. The authors of the study urged that overturning these restrictive policies and broadening access to treatment can effectively reduce HCV rates among this population.

According to Dr Eckman, the US Preventive Services Task Force is currently reviewing and updating guidelines for HCV.

References

Eckman MH, Ward JW, Sherman KE. Cost effectiveness of universal screening for HCV infection in the era of direct-acting, pangenotypic treatment regimens. Clinical Gastroenterology and Hepatology. 2018. https://doi.org/10.1016/j.cgh.2018.08.080

UC researchers recommend universal screening to tackle rise in hepatitis C [news release]. University of Cincinnati’s website. https://www.uc.edu/news/articles/2018/10/n203603.html. Accessed October 17, 2018.