According to a new study, screening all adults for hepatitis C (HCV) is a cost-effective way to improve clinical outcomes of HCV and identify more infected people compared to current recommendations. Using a simulation model, researchers from Boston Medical Center, Massachusetts General Hospital (MGH) and Stanford University found that this expanded screening would increase life expectancy and quality of life while remaining cost-effective.
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 trends have shown a higher incidence rate of HCV among young people. To address this gap in testing, the researchers created simulations to estimate the effectiveness of HCV testing strategies among different age groups. They compared effects of the current testing recommendations; of testing people over 40 years old or over 30 years old, and of 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 study found that screening all adults for would identify more than 250,000 additional people with HCV, increase cure rates from 41 to 61 percent, and reduce death rates for HCV-attributable diseases more than 20 percent, compared with current recommendations.
“When we expanded testing, the results were compelling,” says Joshua Barocas, MD, 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 research team used 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.
All of the age-based strategies decreased costs related to managing chronic HCV and advanced liver disease, but 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, PhD, 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.
“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, MD, 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.”
The study was published online in Clinical Infectious Diseases and was funded by the National Institute on Drug Abuse at the National Institutes of Health, the MGH Fund of Medical Delivery and the U.S. Centers for Disease Control and Prevention.
Boston Medical Center is a private, not-for-profit, 567-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Committed to providing high-quality health care to all, the hospital offers a full spectrum of pediatric and adult care services including primary and family medicine and advanced specialty care with an emphasis on community-based care. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $116 million in sponsored research funding in fiscal year 2017. It is the 15th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. It does business in Massachusetts as BMC HealthNet Plan and as Well Sense Health Plan in New Hampshire, serving 332,000 people, collectively. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet – 14 community health centers focused on providing exceptional health care to residents of Boston.
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $900 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2017 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."
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