Screening all adults for hepatitis C (HCV) is the most cost-effective way to identify more people with the disease as well as improve patients’ health and quality of life, compared to the current recommendations of screening only certain populations.
Hepatitis C is a viral infection that causes liver inflammation and sometimes serious liver damage. Many people with HCV experience neuropsychiatric symptoms such as brain fog, confusion, irritability, difficulty concentrating, and fatigue. These symptoms make it difficult to carry on everyday tasks.
The Centers for Disease Control and Prevention (CDC) currently recommends HCV testing for people born between 1945 and 1965, the highest risk population in the U.S. However, recent statistics have shown a growing incidence rate of HCV among young people.
“Due in part to the opioid epidemic and the increase in injection drug use, the country has seen an increase in cases of HCV among young people,” says Benjamin Linas, M.D., co-senior author of the study and infectious disease physician at BMC and an associate professor of medicine at Boston University Medical Center. “The CDC could address this public health concern by recommending all adults receive a one-time HCV test.”
To address this gap in testing, researchers from Boston Medical Center, Massachusetts General Hospital (MGH), and Stanford University created a simulation model to estimate the effectiveness of HCV testing strategies among different age groups.
They compared the effects of testing four age brackets: current testing recommendations (those born between 1945 and 1965), testing people over 40 years old, testing people over 30 years old, and 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 researchers discovered that, compared to current recommendations, screening all adults over 18 for HCV would identify more than 250,000 additional people with the disease, increase cure rates from 41 percent to 61 percent, and reduce death rates for HCV-attributable diseases by more than 20 percent. Overall, screening for all adults would increase life expectancy and quality of life while remaining cost-effective.
“When we expanded testing, the results were compelling,” says Joshua Barocas, M.D., lead author on the study, an infectious disease physician at MGH and an instructor in medicine at Harvard Medical School. “Changing the current recommendations could have a major public health impact, improving the quality of life for young people with HCV, and reducing death rates.”
The study pulled data from national databases, clinical trials, and observational cohorts to inform their simulation models, which took into account the same demographics and HCV epidemiology of the U.S. population.
Although all of the age-based strategies lowered costs associated with managing chronic HCV and advanced liver disease, 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.
“Testing all adults would lead to earlier diagnosis and treatment for many people, which would help to prevent cirrhosis and other long-term complications,” says Joshua Salomon, Ph.D., co-senior author of the study and professor of medicine at Stanford University. “Overall, when you consider both the better health outcomes and the reduced costs of managing long-term liver disease, expanded testing offers excellent value for money.”
Researchers say these findings should be considered by the CDC for future recommendations on HCV testing.
Source: Boston Medical Center