Cost-Effectiveness Analysis of Testing Approaches for Diagnosis of Hepatitis C Among US Adults

Abstract Background Diagnosis of infection with hepatitis C virus (HCV) is the first step to accessing curative treatment, yet many infected adults in the United States are unaware of their infection. Viral-first HCV testing strategies may improve diagnosis. We assessed the cost-effectiveness of several hepatitis C testing strategies compared with the currently recommended testing algorithm. Methods We used a decision tree framework with a Markov model of hepatitis C disease progression, to model a cohort representative of US adults at average risk. We modeled 4 strategies: anti-HCV test with automatic nucleic acid test (NAT) for HCV RNA when the anti-HCV result is reactive (comparator); anti-HCV test with automatic hepatitis C core antigen (HCVcAg) test when the anti-HCV result is reactive, followed by NAT for HCV RNA when the HCVcAg result is not reactive (intervention 1); concurrent anti-HCV and HCVcAg tests with automatic NAT for HCV RNA for discordant anti-HCV and HCVcAg results (intervention 2); and NAT for HCV RNA (intervention 3). We compared costs (in 2023 US dollars), quality-adjusted life-years (QALYs) and epidemiologic outcomes for the lifetime of the cohort. Results Relative to the comparator, intervention 1 resulted in the same number of HCV diagnoses and subsequent health outcomes, with cost savings of $0.26 per person. Interventions 2 and 3 had increased costs per person ($8.60 2 and $21.48, respectively) and resulted in an increase in diagnosed infections, treated infections, and QALYs. Conclusions Compared with the current HCV testing approach, viral-first HCV testing approaches are potentially cost-effective strategies that resulted in gains in diagnoses and health outcomes.