Impact of Hepatitis C Screening in Outpatient Population

Abstract

Introduction: For patients born between 1945 and 1965 with no identifiable risk factors, one-time Hepatitis C (HCV) screening test was recommended by CDC and USPSTF in 2012 and 2013 respectively. In January 2014, the state of New York mandated the offer of HCV screening for this cohort. We performed a retrospective study investigating the benefits of cohort-based HCV screening in terms of identification of asymptomatic HCV infection and its treatment in a city hospital ambulatory care setting. Methods: Patients born between 1945 and 1965, screened for HCV in primary care clinic were divided into 2 groups. The first group consisted of patients screened between 7/1/2012-12/31/2013 and the second between 1/1/2014-7/1/2015 after the NY law was passed. Patients with high risk factors including deranged LFT were excluded. Results: Since 1/1/2014, 3206 patients were screened and 1.06% (n=34) tested positive for HCV antibody test. Among these, 7 had detectable viral load on HCV PCR testing, and 6 were treated and cured with sustained virologic response. 16 had undetectable viral load, and 11 were lost to follow up after initial antibody testing. At our setting HCV antibody test costs $74, and $237,244 was spent in diagnosing 6 patients who underwent curative treatment. Thus, at least $39,541 was spent per diagnosis, which along with the average treatment cost, is much lower than the average cost of a untreated HCV infection with chronic liver disease and related complications. Among the 34 patients with positive HCV antibody, 61.76% were women, 47% were Asians, with Black (41%) as the next majority. 26% patients were from US and Guyana each. Only 244 patients were screened during the 18 months prior to the law, resulting in 1 positive HCV antibody test with undetectable viral load. Conclusion: According to the CDC, approximately 3.5 million people in US have chronic HCV infection and approximately 3/4th of this population is accounted by baby boomers born between 1945 - 1965. Many of these people are unaware about being infected with HCV. HCV reached the highest recorded number of 19,649 fatalities in 2014 in US, which surpasses the total combined fatalities linked to 60 other infectious diseases. Barriers to HCV screening and treatment include lack of awareness, insurance, homelessness, incarceration, provider failure to test and refer, and fear of side effects. Our study demonstrates the cost effectiveness of cohort based HCV screening in a city hospital setting, in accordance to the US national data.