Universal HCV Screening in Hospitalised Patients in France: It Could Be a Good Option! The DEVICHO Study

Area of Science:

• Hepatology and Infectious Diseases
• Public Health and Epidemiology
• Health Economics

Background:

• Hepatitis C virus (HCV) infection treatment in France is accessible, but screening relies on risk factors, making universal screening debated.
• Hospitalized patients represent a population with potentially higher HCV prevalence than the general population.
• Assessing the cost-effectiveness of universal screening in a hospital setting is crucial for optimizing public health strategies.

Purpose of the Study:

• To evaluate the effectiveness and cost-benefit of universal HCV screening among hospitalized patients in France.
• To determine the prevalence of HCV infection within this specific patient cohort.
• To compare universal screening with traditional, risk-based screening methods.

Main Methods:

• Prospective DEVICHO study conducted from November 2019 to November 2021 across 22 hospital departments.
• Universal screening for HCV offered to all hospitalized patients, with data compared to patients screened outside the study.
• Analysis included HCV antibody (HCV-Ab) and RNA positivity, treatment rates, sustained virological response, and cost-effectiveness calculations.

Main Results:

• A total of 25,663 patients were invited, with 19.4% (Group 1) participating in universal screening vs. 7% (Group 2) in routine screening.
• HCV-Ab positivity was 2.9% (199/6789), with 14.6% (29/199) of those being HCV-RNA positive (viremic).
• Universal screening was more effective and cost-effective (€11,060 per RNA infection, €36,600 per cure) than routine screening, despite higher upfront costs.

Conclusions:

• Hospital-based universal HCV screening is efficient, identifying a higher prevalence of infection compared to the general population.
• The strategy is cost-effective, with costs per identified infection and cure below France's GDP per capita.
• Healthcare professional engagement and improved linkage to care are critical barriers to overcome for successful implementation.