Optimising hepatitis C screening by use of HCV antigen test

Abstract

Testing strategies for hepatitis C virus (HCV) infection that use a serological test for HCV antigen in HCV antibody-positive patients are more effective at detecting active infections, improve screening efficiency and are cost effective in Russia. This is the main finding of a study that used a decision-analytic model for a hypothetical population eligible for HCV screening in Russia to evaluate the cost effectiveness of four screening strategies: (I) screen for HCV antibodies (AB), nucleic acid test for HCV RNA if AB+; (II) screen for AB, reflexed test for HCV antigen (AG) if AB+, RNA if AG–; (III) screen for AB, reflexed test for AG if AB+; (IV) screen for AG.* The analysis was performed from a health system perspective. The model showed that strategies II, III and IV detected an additional number of active HCV infections, compared with strategy I (820, 793 and 1233, respectively, per 100 000 patients screened). Mean costs were highest for strategy IV ($US58.95), and lowest for strategy III ($42.85). Strategy I had the highest average costs per diagnosed infection ($3681), and strategy III had the lowest average cost per diagnosed infection ($2177). Strategy III was the most effective and least costly option, whereas strategy IV, the singlemarker screening strategy, was not cost effective. Testing strategies with HCV antigen on HCV antibody positive cases offer a streamlining opportunity for population screening programs, suggest the researchers.