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The costs and impacts of testing for hepatitis C virus antibody in public STD clinics
Amanda A Honeycutt1, Jennie L Harris, Olga Khavjou
1RTI International, Research Triangle Park, NC, USA. honeycutt@rti.org
Insights
Testing sexually transmitted disease (STD) clinic subgroups for hepatitis C virus (HCV) antibodies is cost-effective, especially for injection drug users (IDUs). Expanding testing to certain non-IDU groups may also be beneficial.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Hepatitis C virus (HCV) infection is a significant public health concern.
- Sexually transmitted disease (STD) clinics serve populations at high risk for HCV.
- Cost-effectiveness of HCV screening in STD clinics requires evaluation.
Purpose of the Study:
- To estimate the cost and cost-effectiveness of screening specific subgroups within STD clinics for HCV antibodies.
- To determine the economic feasibility of expanding HCV testing beyond high-risk groups.
Main Methods:
- Cost data for HCV counseling, testing, and referral (CTR) were gathered from STD clinics and literature, reported in 2006 dollars.
- Effectiveness was defined as the proportion of targeted clients with a true positive HCV antibody test who returned for results.
- Cost per true positive was calculated for injection drug users (IDUs) returning for results; cost-effectiveness was assessed for expanding to non-IDU subgroups.
Main Results:
- The estimated cost per true positive IDU who returned for test results was $54.
- The cost-effectiveness of expanding HCV CTR to non-IDU subgroups varied widely, ranging from $179 to $2,986.
- Estimates were most sensitive to variations in HCV prevalence, testing costs, and client return rates.
Conclusions:
- HCV antibody testing in STD clinics is highly cost-effective for IDUs.
- Expanding HCV CTR to non-IDU men over 40 with over 100 lifetime partners may be cost-effective for some clinics.
- STD clinics can utilize these estimates to evaluate the feasibility of broadening HCV CTR services beyond IDUs.
Objectives:
To estimate the cost and cost-effectiveness of testing sexually transmitted disease (STD) clinic subgroups for antibodies to hepatitis C virus (HCV).
Methods:
HCV counseling, testing, and referral (CTR) costs were estimated using data from two STD clinics and the literature, and are reported in 2006 dollars. Effectiveness of HCV CTR was defined as the estimated percentage of clinic clients in subgroups targeted for HCV antibody (anti-HCV) testing who had a true positive test and returned for their test results. We estimated the cost per true positive injection drug user (IDU) who returned for anti-HCV test results and the cost-effectiveness of expanding HCV CTR to non-IDU subgroups.
Results:
The estimated cost per true positive IDU who returned for test results was $54. The cost-effectiveness of expanding HCV CTR to non-IDU subgroups ranged from $179 to $2,986. Our estimates were most sensitive to variations in HCV prevalence, the cost of testing, and the rate of client return.
Conclusions:
Based on national data, testing IDUs in the STD clinic setting is highly cost-effective. Some clinics may find that it is cost-effective to expand testing to non-IDU men older than 40 who report more than 100 lifetime sex partners. STD clinics can use study estimates to assess the feasibility and desirability of expanding HCV CTR beyond IDUs.
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