Cost-Effectiveness of HCV Screening in Emergency Departments Using DETECT Hep C Trial Results

Nontargeted hepatitis C virus (HCV) screening in emergency departments (EDs) has been demonstrated to identify more patients with HCV than targeted screening. Cost-effectiveness is key to strategy selection; however, the cost-effectiveness of these strategies in EDs remains unknown.

To compare clinical outcomes and cost-effectiveness of 2 novel ED-based HCV screening strategies with no ED HCV screening.

In this economic evaluation study, a cohort of individuals presenting to the ED in the US was simulated with data from the Determining Effective Testing in Emergency Departments and Care Coordination on Treatment Outcomes for Hepatitis C Screening (DETECT Hep C) trial using the Hepatitis C Cost-Effectiveness (HEP-CE) model from a health sector perspective. Using data from EDs at Denver Health Medical Center, Johns Hopkins Hospital, and the University of Mississippi Medical Center, 3 strategies were simulated over a lifetime horizon, including (1) no ED HCV screening, (2) targeted HCV screening, and (3) nontargeted HCV screening. Data were collected from November 2019 to August 2022 and analyzed from December 2021 to July 2026.

HCV screening in the ED.

The primary outcomes were remaining life expectancy, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and costs (2024 US dollars). An annual discount rate of 3% was applied to future costs and benefits when calculating ICERs. An ICER of less than $100 000 per QALY gained was considered cost-effective.

A simulated cohort with a total of 500 million individuals (mean [SD] age, 46.3 [17.2] years; 264.4 million male [52.88%]) were included in this analysis. Nontargeted HCV screening yielded the best clinical and cost-effectiveness outcomes in the base case cohort, with 65.89% of infections being cured, a discounted cost of $214 465, discounted quality-adjusted life expectancy of 15.8723 QALYs, and an ICER of $12 820 per QALY gained. Compared with nontargeted HCV screening, no ED HCV screening and targeted HCV screening, respectively, had fewer infections cured (65.60% and 65.88%), lower QALYs (15.8717 QALYs and 15.8721 QALYs), and similar discounted costs ($214 467 and $214 462). Absolute benefits appeared narrow because over 90% of those screened did not have HCV; however, benefits were clear among those living with HCV infection.

Results of this economic evaluation study suggest that nontargeted HCV screening was cost-effective when compared with no HCV screening or targeted HCV screening in the ED. Implementing routine nontargeted HCV screening in emergency departments provides good economic value and could be an important pillar of HCV elimination.