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Economic Impact of Universal Hepatitis C Virus Testing for Middle-Aged Adults Who Inject Drugs

Published:October 15, 2022DOI:https://doi.org/10.1016/j.amepre.2022.08.016

      Introduction

      The objective of this study was to estimate the economic impact of providing universal hepatitis C virus testing in commercially insured middle-aged persons who inject drugs in the U.S.

      Methods

      This study developed a dynamic 10-year economic model to project the clinical and economic outcomes associated with hepatitis C virus testing among middle-aged adult persons who inject drugs, from a payer's perspective. Costs related to hepatitis C virus testing, direct-acting antiviral, and liver-related outcomes between the (1) current hepatitis C virus testing rate (i.e., 8%) and (2) universal hepatitis C virus testing rate (i.e., 100%) were compared. Among patients testing positive, 21% of those without cirrhosis and 48% of those with cirrhosis were assumed to initiate direct-acting antivirals. Sensitivity analyses were performed to identify variables (e.g., direct-acting antiviral drug costs, hepatitis C virus testing costs, direct-acting antiviral treatment rate) influencing this study's conclusion.

      Results

      The model predicts that during the 10-year period, universal hepatitis C virus testing will cost an additional $242 per person who injects drugs to the payers’ healthcare budgets compared with the current scenario. Sensitivity analyses showed values ranging from $1,656 additional costs to $1,085 cost savings across all varied parameters and scenarios. A total of 80% of the current direct-acting antiviral costs indicated that cost savings will be $383 per person who injects drugs.

      Conclusions

      Universal hepatitis C virus testing among persons who inject drugs would not achieve cost savings within 10 years, with the cost of direct-acting antivirals contributing the most to the spending. To promote universal hepatitis C virus testing among persons who inject drugs, decreasing direct-acting antiviral costs and sustainable funding streams for hepatitis C virus testing should be considered.
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      REFERENCES

        • Ryerson AB
        • Schillie S
        • Barker LK
        • Kupronis BA
        • Wester C.
        Vital signs: newly reported acute and chronic hepatitis C cases – United states, 2009-2018.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 399-404https://doi.org/10.15585/mmwr.mm6914a2
      1. Screen all adult patients for hepatitis C. Centers for Disease Control and Prevention. https://www.cdc.gov/knowmorehepatitis/hcp/Screen-All-Patients-For-HepC.htm. Updated June 14, 2021. Accessed January 10, 2022.

      2. Table 3.6 of 2019 viral hepatitis surveillance report.
        Centers for Disease Control and Prevention, 2021 (Updated May 14. Accessed January 10, 2022)
      3. Viral Hepatitis Surveillance Report 2019. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/statistics/2019surveillance/HepC.htm. Updated May 14, 2021. Accessed January 10, 2022.

        • Bull-Otterson L
        • Huang YLA
        • Zhu W
        • King H
        • Edlin BR
        • Hoover KW.
        Human immunodeficiency virus and hepatitis C virus infection testing among commercially insured persons who inject drugs, United States, 2010-2017.
        J Infect Dis. 2020; 222 (6): 940-947https://doi.org/10.1093/infdis/jiaa337
        • Jiang X
        • Parker RL
        • Vouri SM
        • et al.
        Cascade of hepatitis C virus care among patients with substance use disorders.
        Am J Prev Med. 2021; 61: 576-584https://doi.org/10.1016/j.amepre.2021.04.013
        • Frimpong JA
        • D'Aunno T
        Hepatitis C testing in substance use disorder treatment: the role of program managers in adoption of testing services.
        Subst Abuse Treat Prev Policy. 2016; 11: 13https://doi.org/10.1186/s13011-016-0057-2
        • Behrends CN
        • Kapadia SN
        • Schackman BR
        • Frimpong JA.
        Addressing barriers to on-site HIV and HCV testing services in methadone maintenance treatment programs in the United States: findings from a national multisite qualitative study.
        J Public Health Manag Pract. 2021; 27: 393-402https://doi.org/10.1097/PHH.0000000000001262
        • Schackman BR
        • Gutkind S
        • Morgan JR
        • et al.
        Cost-effectiveness of hepatitis C screening and treatment linkage intervention in US methadone maintenance treatment programs.
        Drug Alcohol Depend. 2018; 185: 411-420https://doi.org/10.1016/j.drugalcdep.2017.11.031
        • Younossi Z
        • Blissett D
        • Blissett R
        • et al.
        In an era of highly effective treatment, hepatitis C screening of the United States general population should be considered.
        Liver Int. 2018; 38: 258-265https://doi.org/10.1111/liv.13519
        • Durham DP
        • Skrip LA
        • Bruce RD
        • et al.
        The impact of enhanced screening and treatment on hepatitis C in the United States.
        Clin Infect Dis. 2016; 62: 298-304https://doi.org/10.1093/cid/civ894
        • Tatar M
        • Keeshin SW
        • Mailliard M
        • Wilson FA.
        Cost-effectiveness of universal and targeted hepatitis C virus screening in the United States.
        JAMA Netw Open. 2020; 3e2015756https://doi.org/10.1001/jamanetworkopen.2020.15756
        • Assoumou SA
        • Nolen S
        • Hagan L
        • et al.
        Hepatitis C management at federally qualified health centers during the opioid epidemic: a cost-effectiveness study.
        Am J Med. 2020; 133: e641-e658https://doi.org/10.1016/j.amjmed.2020.05.029
        • Rein DB
        • Smith BD
        • Wittenborn JS
        • et al.
        The cost-effectiveness of birth-cohort screening for hepatitis C antibody in U.S. primary care settings.
        Ann Intern Med. 2012; 156: 263-270https://doi.org/10.7326/0003-4819-156-4-201202210-00378
        • Husereau D
        • Drummond M
        • Petrou S
        • et al.
        Consolidated health economic evaluation reporting standards (CHEERS) statement.
        Int J Technol Assess Health Care. 2013; 29: 117-122https://doi.org/10.1017/S0266462313000160
        • U.S. Preventive Service Task Force
        Final recommendation statement hepatitis C: hepatitis C virus infection in adolescents and adults: screening.
        Preventive Service Task Force, Rockville, MD: U.S2020 (Accessed January 10, 2022)
        • Barocas JA
        • Tasillo A
        • Eftekhari Yazdi G
        • et al.
        Population-level outcomes and cost-effectiveness of expanding the recommendation for age-based hepatitis C testing in the United States.
        Clin Infect Dis. 2018; 67: 549-556https://doi.org/10.1093/cid/ciy098
        • Tang W
        • Chen W
        • Amini A
        • et al.
        Diagnostic accuracy of tests to detect hepatitis C antibody: a meta-analysis and review of the literature.
        BMC Infect Dis. 2017; 17: 695https://doi.org/10.1186/s12879-017-2773-2
        • Park H
        • Jiang X
        • Song HJ
        • et al.
        The impact of direct-acting antiviral therapy on end-stage liver disease among individuals with chronic hepatitis C and substance use disorders.
        Hepatology. 2021; 74: 566-581https://doi.org/10.1002/hep.31732
        • Vázquez-Morón S
        • Ardizone Jiménez B
        • Jiménez-Sousa MA
        • Bellón JM
        • Ryan P
        • Resino S
        Evaluation of the diagnostic accuracy of laboratory-based screening for hepatitis C in dried blood spot samples: a systematic review and meta-analysis.
        Sci Rep. 2019; 9: 7316https://doi.org/10.1038/s41598-019-41139-8
        • Jiang X
        • Vouri SM
        • Diaby V
        • Lo-Ciganic W
        • Parker R
        • Park H.
        Health care utilization and costs associated with direct-acting antivirals for patients with substance use disorders and chronic hepatitis C.
        J Manag Care Spec Pharm. 2021; 27: 1388-1402https://doi.org/10.18553/jmcp.2021.27.10.1388
        • Jiang X
        • Guy Jr, GP
        • Dunphy C
        • Pickens CM
        • Jones CM
        Characteristics of adults reporting illicitly manufactured fentanyl or heroin use or prescription opioid misuse in the United States, 2019.
        Drug Alcohol Depend. 2021; 229109160https://doi.org/10.1016/j.drugalcdep.2021.109160
        • Jiang X
        • Song HJ
        • Wang W
        • et al.
        The use of all-oral direct-acting antivirals in hepatitis C virus-infected patients with substance use disorders.
        J Manag Care Spec Pharm. 2021; 27: 873-881https://doi.org/10.18553/jmcp.2021.27.7.873
        • Liu S
        • Watcha D
        • Holodniy M
        • Goldhaber-Fiebert JD.
        Sofosbuvir-based treatment regimens for chronic, genotype 1 hepatitis C virus infection in U.S. incarcerated populations: a cost-effectiveness analysis.
        Ann Intern Med. 2014; 161: 546-553https://doi.org/10.7326/M14-0602
        • Bruno S
        • Zuin M
        • Crosignani A
        • et al.
        Predicting mortality risk in patients with compensated HCV-induced cirrhosis: a long-term prospective study.
        Am J Gastroenterol. 2009; 104: 1147-1158https://doi.org/10.1038/ajg.2009.31
        • Xu F
        • Moorman AC
        • Tong X
        • et al.
        All-cause mortality and progression risks to hepatic decompensation and hepatocellular carcinoma in patients infected with hepatitis C virus.
        Clin Infect Dis. 2016; 62: 289-297https://doi.org/10.1093/cid/civ860
        • Fattovich G
        • Giustina G
        • Degos F
        • et al.
        Effectiveness of interferon alfa on incidence of hepatocellular carcinoma and decompensation in cirrhosis type C. European Concerted Action on Viral Hepatitis (EUROHEP).
        J Hepatol. 1997; 27: 201-205https://doi.org/10.1016/S0168-8278(97)80302-9
        • Mattingly TJ
        • Love BL.
        Changes in cost-effectiveness for chronic hepatitis C virus pharmacotherapy: the case for continuous cost-effectiveness analyses.
        J Manag Care Spec Pharm. 2020; 26: 879-886https://doi.org/10.18553/jmcp.2020.26.7.879
        • Backus LI
        • Belperio PS
        • Shahoumian TA
        • Loomis TP
        • Mole LA.
        Comparative effectiveness of ledipasvir/sofosbuvir±ribavirin vs. ombitasvir/paritaprevir/ritonavir+ dasabuvir±ribavirin in 6961 genotype 1 patients treated in routine medical practice.
        Aliment Pharmacol Ther. 2016; 44: 400-410https://doi.org/10.1111/apt.13696
        • Morgan RL
        • Baack B
        • Smith BD
        • Yartel A
        • Pitasi M
        • Falck-Ytter Y.
        Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: a meta-analysis of observational studies.
        Ann Intern Med. 2013; 158: 329-337https://doi.org/10.7326/0003-4819-158-5-201303050-00005
        • Thein HH
        • Yi Q
        • Dore GJ
        • Krahn MD.
        Estimation of stage-specific fibrosis progression rates in chronic hepatitis C virus infection: a meta-analysis and meta-regression.
        Hepatology. 2008; 48: 418-431https://doi.org/10.1002/hep.22375
        • Younossi ZM
        • Park H
        • Dieterich D
        • Saab S
        • Ahmed A
        • Gordon SC.
        Assessment of cost of innovation versus the value of health gains associated with treatment of chronic hepatitis C in the United States: the quality-adjusted cost of care.
        Medicine (Baltimore). 2016; 95: e5048https://doi.org/10.1097/MD.0000000000005048
        • Di Martino V
        • Crouzet J
        • Hillon P
        • Thévenot T
        • Minello A
        • Monnet E.
        Long-term outcome of chronic hepatitis C in a population-based cohort and impact of antiviral therapy: a propensity-adjusted analysis.
        J Viral Hepat. 2011; 18: 493-505https://doi.org/10.1111/j.1365-2893.2011.01476.x
        • Dienstag JL
        • Ghany MG
        • Morgan TR
        • et al.
        A prospective study of the rate of progression in compensated, histologically advanced chronic hepatitis C.
        Hepatology. 2011; 54: 396-405https://doi.org/10.1002/hep.24370
        • Chhatwal J
        • Kanwal F
        • Roberts MS
        • Dunn MA.
        Cost-effectiveness and budget impact of hepatitis C virus treatment with sofosbuvir and ledipasvir in the United States.
        Ann Intern Med. 2015; 162: 397-406https://doi.org/10.7326/M14-1336
        • Younossi ZM
        • Park H
        • Saab S
        • Ahmed A
        • Dieterich D
        • Gordon SC.
        Cost-effectiveness of all-oral ledipasvir/sofosbuvir regimens in patients with chronic hepatitis C virus genotype 1 infection.
        Aliment Pharmacol Ther. 2015; 41: 544-563https://doi.org/10.1111/apt.13081
        • Park H
        • Jeong D
        • Nguyen P
        • et al.
        Economic and clinical burden of viral hepatitis in California: A population-based study with longitudinal analysis.
        PLoS One. 2018; 13e0196452https://doi.org/10.1371/journal.pone.0196452
        • Amin J
        • Law MG
        • Bartlett M
        • Kaldor JM
        • Dore GJ.
        Causes of death after diagnosis of hepatitis B or hepatitis C infection: a large community-based linkage study.
        Lancet. 2006; 368: 938-945https://doi.org/10.1016/S0140-6736(06)69374-4
        • American Medical Association
        2018 Clinical Diagnostic Laboratory Fee Schedule.
        American Medical Association, Chicago, IL2019 (Accessed August 20, 2020)
        • Garg M
        • Park H.
        PIN30 Impact of disease severity on healthcare costs in patients with chronic hepatitis C virus infection (HCV).
        Value Health. 2019; 22: S199https://doi.org/10.1016/j.jval.2019.04.901
        • Wong WW
        • Haines A
        • Farhang Zangneh H
        • Shah H
        Can we afford not to screen and treat hepatitis C virus infection in Canada?.
        Can Liver J. 2018; 1: 51-65https://doi.org/10.3138/canlivj.1.2.005
        • Owens DK
        • Davidson KW
        • et al.
        • U.S. Preventive Services Task Force
        Screening for hepatitis C virus infection in adolescents and adults: U.S. Preventive Services Task Force recommendation statement.
        JAMA. 2020; 323: 970-975https://doi.org/10.1001/jama.2020.1123
        • Schillie S
        • Wester C
        • Osborne M
        • Wesolowski L
        • Ryerson AB.
        CDC recommendations for hepatitis C screening among adults – United States, 2020.
        MMWR Recomm Rep. 2020; 69: 1-17https://doi.org/10.15585/mmwr.rr6902a1
        • Neblett Fanfair RN
        • Shrestha RK
        • Randall L
        • et al.
        Implementing data to care-what are the costs for the health department?.
        J Acquir Immune Defic Syndr. 2019; 82: S57-S61https://doi.org/10.1097/QAI.0000000000001968
        • Lin F
        • Farnham PG
        • Shrestha RK
        • Mermin J
        • Sansom SL.
        Cost effectiveness of HIV prevention interventions in the U.S.
        Am J Prev Med. 2016; 50: 699-708https://doi.org/10.1016/j.amepre.2016.01.011
        • Turner BJ
        • Taylor BS
        • Hanson JT
        • et al.
        Implementing hospital-based baby boomer hepatitis C virus screening and linkage to care: strategies, results, and costs.
        J Hosp Med. 2015; 10: 510-516https://doi.org/10.1002/jhm.2376
        • Shrestha RK
        • Clark HA
        • Sansom SL
        • et al.
        Cost-effectiveness of finding new HIV diagnoses using rapid HIV testing in community-based organizations.
        Public Health Rep. 2008; 123 (3): 94-100https://doi.org/10.1177/00333549081230S312
        • Park H
        • Song HJ
        • Jiang X
        • Henry L
        • Cook RL
        • Nelson DR.
        Direct-acting antiviral treatment use remains low among Florida Medicaid beneficiaries with chronic hepatitis C.
        Hepatol Commun. 2021; 5: 203-216https://doi.org/10.1002/hep4.1634
        • Fang H
        • Frean M
        • Sylwestrzak G
        • Ukert B.
        Trends in disenrollment and reenrollment within U.S. commercial health insurance plans, 2006–2018.
        JAMA Netw Open. 2022; 5e220320https://doi.org/10.1001/jamanetworkopen.2022.0320
        • Center on Budget and Policy Priorities
        Medicaid works for people with substance use disorders.
        Center on Budget and Policy Priorities, Washington, DC2018 (Accessed August 20, 2020)
        • Falade-Nwulia O
        • Sulkowski MS
        • Merkow A
        • Latkin C
        • Mehta SH.
        Understanding and addressing hepatitis C reinfection in the oral direct-acting antiviral era.
        J Viral Hepat. 2018; 25: 220-227https://doi.org/10.1111/jvh.12859
        • Park H
        • Wang W
        • Henry L
        • Nelson DR.
        Impact of all-oral direct-acting antivirals on clinical and economic outcomes in chronic hepatitis C patients in the United States.
        Hepatology. 2018; 69: 1032-1045https://doi.org/10.1002/hep.30303
        • Wang W
        • Lo Re III, V
        • Guo Y
        • Xiao H
        • Brown J
        • Park H
        Impact of hepatitis C virus treatment on the risk of non-hepatic cancers among hepatitis C virus-infected patients in the U.S.
        Aliment Pharmacol Ther. 2020; 52: 1592-1602https://doi.org/10.1111/apt.16081
        • Linthicum MT
        • Gonzalez YS
        • Mulligan K
        • et al.
        Value of expanding HCV screening and treatment policies in the United States.
        Am J Manag Care. 2016; 22 (Spec No.): SP227-SP235