Population-level outcomes and cost-effectiveness of expanding the recommendation for age-based hepatitis c testing in the United States

Background. The US Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend onetime hepatitis C virus (HCV) testing for persons born 1945-1965 and targeted testing for high-risk persons. This strategy targets HCV testing to a prevalent population at high risk for HCV morbidity and mortality, but does not include younger populations with high incidence. To address this gap and improve access to HCV testing, age-based strategies should be considered. Methods. We used a simulation of HCV to estimate the effectiveness and cost-effectiveness of HCV testing strategies: 1) standard of care (SOC) - recommendation for one-time testing for all persons born 1945-1965, 2) recommendation for one-time testing for adults >40 years (>40 strategy), 3) >30 years (>30 strategy), and 4) >18 years (>18 strategy). All strategies assumed targeted testing of high-risk persons. Inputs were derived from national databases, observational cohorts and clinical trials. Outcomes included quality-adjusted life expectancy, costs, and cost-effectiveness. Results. Expanded age-based testing strategies increased US population lifetime case identification and cure rates. Greatest increases were observed in the >18 strategy. Compared to the SOC, this strategy resulted in an estimated 256,000 additional infected persons identified and 280,000 additional cures at the lowest cost per QALY gained (ICER = $28,000/QALY). Conclusions. In addition to risk-based testing, one-time HCV testing of persons 18 and older appears to be cost-effective, leads to improved clinical outcomes and identifies more persons with HCV than the current birth cohort recommendations. These findings could be considered for future recommendation revisions. © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.