Targeting all adults for hepatitis C virus testing may identify more cases and improve cure rates.
Public health organizations have long been urging baby boomers at get tested for hepatitis C virus (HCV), as this population is historically considered the most at-risk for the infection. However, an increase in HCV rates among younger injection drug users has caused a gap in testing that could leave this population at risk for chronic infection and organ damage that will lead to higher medical costs down the line.
A study published by Clinical Infectious Diseases suggests that screening all adults for HCV may be cost-effective and could also identify more patients with the infection than current recommendations.
To address the disparities in testing rates, the study authors developed simulations to determine the efficacy of HCV testing strategies among different age groups. Data from databases, clinical trials, and observational cohorts were included in the study.
Specifically, the researchers looked at current recommendations for testing individuals over 30 years of age or those over 40 years of age, and testing all adults over 18 years. Both approaches also targeted high-risk individuals, according to the authors.
The results suggest that testing all adults would lead to 250,000 more HCV diagnoses and increase cure rates from 41% to 61%, according to the study.
Additionally, widespread testing would also reduce the risk of death from HCV-linked conditions by more than 20% compared with current guidelines.
“When we expanded testing, the results were compelling,” said lead author Joshua Barocas, MD. “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.”
Although age-based strategies reduced costs associated with managing HCV and associated liver disease, the authors discovered that testing all adults was the most cost-effective approach overall.
The cost benefit of the testing-all-adults strategy remained true even in a simulation that required double the amount of testing to achieve the same number of diagnoses, according to the study.
“Testing all adults would lead to earlier diagnosis and treatment for many people, which would help to prevent cirrhosis and other long-term complications,” said senior author Joshua Salomon, PhD. “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.”
Due to the severity of the opioid epidemic, more Americans are contracting HCV and other blood borne diseases. Despite the seriousness of these conditions, current guidelines may only target traditional risk populations and not injection drug users.
The authors said that these findings could be used by the CDC to guide future HCV testing guidelines.
“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,” said co-senior author Benjamin Linas, MD. “The CDC could address this public health concern by recommending all adults receive a one-time HCV test.”