Emergency Department HCV Screening May Reduce Potential Hepatic Complications, Lower Costs

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Emergency department-based hepatitis C virus (HCV) screenings may diminish potential hepatic complications and lower long-term costs of HCV treatment, according to new findings.¹

These data represent the conclusion of a new study examining the cost-effectiveness of routine HCV screenings in the long-term, as well as linkage-to-care for high-risk individuals in emergency departments from the view of payers.

Sun A Choi—from the department of pharmacy systems at the University of Illinois at Chicago College of Pharmacy—led the team of investigators conducting this analysis. Choi and colleagues noted that HCV screening in the US is not covered by payers in non-primary care settings, adding that a more non-traditional, emergency department-based screening program may be less costly and help to determine infections in vulnerable patients at higher risk.²

“Several studies have demonstrated the feasibility of an (emergency department)-based HCV screening program, but the cost-effectiveness of a program is also important for policy-decision makers,” Choi et al. wrote. “Therefore, we assessed the long-term cost-effectiveness of routine HCV screening and linkage-to-care for high-risk patients in the (emergency department) from the payer’s perspective.”¹

Study Design and Details

The University of Illinois Hospital and Health Sciences System (UIH) carried out an initiative known as Project HEAL (HIV & HCV Screening, Education, Awareness, Linkage-to-Care), during which those who presented to the emergency department were given an opt-out HCV screening provided they were shown to be at high HCV infection risk. They were given subsequent linkage-to-care if they had been infected.

The investigators created a decision-analytic Markov model to simulate the process of screening for HCV in the emergency department and the natural progression of the condition. Over the course of the model, patients who opted not to avoid HCV screening were tested for HCV antibodies, and positive findings automatically triggered an HCV RNA test.

Drawing on data from Project HEAL, the team’s hybrid model implemented a 30-year time horizon with 1-year cycles.

Several pathways for treatment were accounted for by the research team’s model following the first screening. All individuals who underwent emergency department-based HCV screenings were referred for direct-acting antiviral (DAA) therapy regardless of their fibrosis level.

During their analysis, the investigators calculated participants’ total costs related to HCV-associated healthcare, in addition to their quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICERs). These were specifically from the payer’s perspective when unscreened and untreated individuals began DAA treatment at various stages of fibrosis.

Major Findings

The investigators reported that for individuals who were unscreened and untreated, and later given DAA therapy at the fibrosis stages F1, F2, F3, or compensated cirrhosis, the subjects’ incremental cost-effectiveness ratio (ICER) had a range between $6,084 - $77,063 per QALY gained.

However, among the participants who remained untreated until the point of the decompensated cirrhosis stage, it was shown that the cost-effectiveness of screening for HCV was no longer favorable.

Overall, it was concluded by the investigators that emergency department-based screening and linkage-to-care was found to be cost-effective, with the willingness-to-pay (WTP) threshold being $100,000/QALY in all of their scenarios.

“To our knowledge, our study is the first to evaluate the cost-effectiveness of (emergency department)-based HCV screening and linkage-to-care using real-world estimates in the US,” they wrote. “The results indicate that (emergency department)-based HCV screening can reduce potential hepatic complications and lower the long-term HCV treatment costs.”¹

References

1. ^{Choi, S.A., Umashankar, K., Maheswaran, A. et al. Cost-effectiveness analysis of emergency department-based hepatitis C screening and linkage-to-care program. BMC Health Serv Res 24, 1308 (2024). https://doi.org/10.1186/s12913-024-11793-4.}
2. ^{Patel EU, Mehta SH, Boon D, Quinn TC, Thomas DL, Tobian AAR. Limited Coverage of Hepatitis C Virus Testing in the United States, 2013–2017. Clin Infect Dis off Publ Infect Dis Soc Am. 2019;68(8):1402–5.}