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Comparison of effectiveness and cost of different HCV testing strategies in high-risk populations in China
Bing Chen1, Bing Xu2, Hai-Yan Cui3
1Department of Clinical Laboratory, The Second Affiliated Hospital of Anhui Medical University, Anhui, China.
Insights
Identifying hepatitis C virus (HCV) infection in high-risk groups requires efficient testing. Direct HCV RNA testing is preferred, but sensitive anti-HCV screening followed by RNA testing is effective for resource-limited settings.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- High-risk populations disproportionately affected by Hepatitis C Virus (HCV).
- Urgent need for cost-effective HCV testing strategies in these groups.
- Identifying undiagnosed HCV infections is crucial for public health.
Purpose of the Study:
- Compare commonly used HCV testing strategies.
- Analyze effectiveness and cost of different diagnostic approaches.
- Determine the optimal HCV testing strategy for high-risk populations.
Main Methods:
- Retrospective analysis of 2093 samples from high-risk individuals.
- Evaluation of three distinct testing strategies (A, B, C).
- Assessment of detection rates, missed case rates, and costs.
Main Results:
- Strategy B detected all 237 current HCV infections (0% missed) at a cost of 147,221 RMB.
- Strategy A missed 5.06% of current HCV infections (225/237 detected) costing 33,299 RMB.
- Strategy C missed 5.91% of current HCV infections (14 cases) costing 43,059 RMB, primarily identifying past infections.
Conclusions:
- Direct HCV RNA testing is the preferred strategy to minimize missed diagnoses in high-risk populations.
- For resource-limited settings, initial sensitive anti-HCV screening followed by HCV RNA confirmation is recommended.
- Optimizing HCV testing strategies is vital for effective disease control in vulnerable populations.
Abstract:
High-risk populations are the predominant populations affected by hepatitis C virus (HCV) infection, and there is an urgent need for efficient and cost-effective HCV testing strategies for high-risk populations to identify potential undiagnosed HCV-infected individuals. This study compared several commonly used testing strategies and conducted effectiveness and cost analysis to select the appropriate testing strategy for diagnosing HCV infection in high-risk populations. Among the 2093 samples from high-risk populations in this study, 1716 were HCV negative, 237 were current HCV infection, 137 were past HCV infection, and three were acute early HCV infection. It was found that out of 237 patients with HCV current infection, Strategy A could detect 225 cases, with a missed detection rate of 5.06%, and the total cost was 33 299 RMB. In addition, Strategy B could detect 237 cases of current HCV infection, and the HCV missed detection rate was 0.00%, and the total cost was 147 221 RMB. While 137 cases of past HCV infection could be distinguished by strategy C, but 14 cases with current HCV infection were missed, with an HCV-positive missed detection rate of 5.91%, and the total cost for Strategy C was 43 059 RMB. In conclusion, in high-risk populations, the HCV positivity rate is typically higher. If feasible, the preferred approach is to directly conduct HCV RNA testing, which effectively minimizes the risk of missing cases. However, in situations with limited resources, it is advisable to initially choose a highly sensitive method for anti-HCV screening, followed by HCV RNA testing on reactive samples.
