Assoumou SA, et al. - In view of high prevalence of hepatitis C virus (HCV) rates in young people who inject drugs (PWID), authors here evaluated the clinical benefit and cost-effectiveness of one-time hepatitis C screening strategies among adolescents and young adults in primary care settings. As per findings, routine rapid HCV testing among 15 to 30-year-olds could be cost-effective when the prevalence of people who inject drugs (PWID) > 0.59%.

Methods

• A decision analytic model was developed to project quality-adjusted life years (QALYs), lifetime costs (2016 US $), and incremental cost-effectiveness ratios (ICER) associated with nine strategies for one-time testing among 15 to 30-year-olds seen at urban community health centers.
• The strategies showed three differences:
• 1. Targeted vs. routine testing;
• 2. Rapid finger stick vs. standard venipuncture;
• 3. Ordered by physician vs. counselor/tester using standing orders.
• Deterministic and probabilistic sensitivity analyses (PSA) were performed to evaluate uncertainty.

Results

• In comparison to targeted risk-based testing (current standard of care), routine testing seemed increasing lifetime medical cost by $80 and discounted QALYs by 0.0013 per person.
• Across all strategies, rapid testing seemed to provide higher QALYs at a lower cost per QALY gained, and was always preferred.
• Observations revealed that counselor-initiated routine rapid testing was associated with an ICER of $71,000/QALY gained.
• In this work, results seemed sensitive to offer and result receipt rates.
• Counselor-initiated routine rapid testing proved cost-effective (ICER <$100,000/QALY) unless the prevalence of PWID was < 0.59%, HCV prevalence among PWID <16%, reinfection rate >26 cases per 100 person-years, or reflex confirmatory testing followed all reactive venipuncture diagnostics.
• PSA indicated routine rapid as the optimal strategy in 90% of simulations.