Universal Hepatitis C Screening Among Adults and Treatment for Hepatitis C Virus Infection
Prevention Case Study 4
Hepatitis C virus (HCV) can cause a serious and sometimes fatal infection of the liver. The virus is spread primarily when blood from an infected person enters the body of someone who is not infected. For some persons, HCV causes no symptoms or only a mild illness which resolves over a few weeks. For the majority of infected persons, however, untreated HCV causes a serious, chronic illness. In the United States, approximately 2.4 million persons are living with chronic HCV infection,1 44% of whom do not know their HCV status.2 Without screening and diagnosis, these persons cannot take the first step toward lifesaving curative treatment. Without treatment, persons with chronic HCV infection can die prematurely. In 2018, approximately 16,000 persons died in the United States because of chronic HCV infection-related causes.3
In 2020, CDC recommended hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, as well as for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection is <0.1%.4 In addition, hepatitis C testing regardless of age or setting prevalence continues to be recommended for persons with recognized conditions or exposures.4
Hepatitis C screening among all adults and treatment programs save lives and money.
Universal screening among all adults leads to more cures, fewer cases of hepatocellular carcinoma, and increased cost-effectiveness from both a healthcare and societal perspective. Using a cost-effectiveness simulation, screening all adults led to an additional 280,000 people cured, 4,400 fewer cases of hepatocellular carcinoma, and an incremental cost-effectiveness ratio of $28,000 per quality adjusted life years compared with screening only persons born between 1945-1965.5
Treatment for HCV infection can be cost saving from both a societal and payer perspective. A systematic review revealed that the median price at which hepatitis C treatment becomes cost-saving is $70,900 (interquartile range: $43,300–$103,700) in 2014 US dollars,6 and the cost of HCV treatment regimens are within or below that range.
In 2020, the average cost of a 12-week course of treatment was $77,083, ranging from $55,700 – 94,800.7 However, under the Department of Veterans Affairs Federal Supply Schedule, the average cost of a 12-week course of treatment is $37,080.8 Additionally, insurance companies negotiate the lowest prices they are willing to pay for medications and under some commercial plans, the average price continued to decrease by 2018.9
With an estimated 2.4 million persons living with undiagnosed chronic HCV infection in the United States, routine screening and treatment programs for adults are urgently needed to save lives in addition to money. 1,2
- Hofmeister MG, Rosenthal EM, Barker LK, et al. Estimating prevalence of hepatitis C virus infection in the United States, 2013–2016. Hepatology 2019;69:1020–31.
- Kim HS, Yang JD, El-Serag HB, Kanwal F. Awareness of chronic viral hepatitis in the United States: an update from the National Health and Nutrition Examination Survey. J Viral Hepat 2019;26:596–602.
- Centers for Disease Control and Prevention. Viral Hepatitis Surveillance – United States, 2018. Published July 2020. Accessed November 3, 2020.
- Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson AB. CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020. MMWR Recomm Rep 2020;69(No. RR-2):1–17. DOIexternal icon:
- Barocas JA, Tasillo A, Eftekhari Yazdi G, et al. Population-level outcomes and cost-effectiveness of expanding the recommendation for age-based hepatitis C testing in the United States. Clin Infect Dis 2018;67:549–56.
- Chhatwal J, He T, Hur C, Lopez-Olivo MA. Direct-acting antiviral agents for patients with hepatitis C virus genotype 1 infection are cost-saving. Clin Gastroenterol Hepatol 2017;15:827–37.
- Murell D. How much does treatment for hepatitis C cost?external icon Accessed November 9, 2020.
- US Department of Veterans Affairs. VA Federal Supply Schedule Serviceexternal icon. Accessed November 25, 2020.
- Express Scripts. 2018 drug trend reportpdf iconexternal icon. Accessed November 25, 2020.