- Design
- Economic evaluation using trial data and a simulation model
- Population
- Simulated US emergency department patients
- Primary outcome
- QALYs, costs and incremental cost-effectiveness ratio
- Effect
- Non-targeted screening ICER about $12,820 per QALY gained
An economic evaluation in JAMA Internal Medicine used data from the DETECT Hep C trial at three US emergency departments to model no screening, targeted screening of people with risk factors, and non-targeted screening of all adults.
Non-targeted screening cured the most infections and was cost-effective, at about $12,820 per QALY gained, well below the $100,000 threshold used. Gains per person screened were small because over 90% did not have hepatitis C, but were substantial for those who did.
Many patients with hepatitis C, particularly those who use drugs or have unstable housing, rarely see primary care, and their only contact may be an acute visit or admission. Testing every adult who has blood drawn reaches them.
This was US modelling using US costs. For hospital physicians, the principle carries over: an acute presentation is an opportunity to test.
- Offer hepatitis C testing to adults having blood taken in the emergency department or on admission, where local policy allows
- Arrange linkage to treatment before discharge for anyone who tests positive
- Use reflex RNA testing on a positive antibody where available, to avoid a second visit
Why it matters
For some patients the emergency department is the only point of contact with the health system.
Don't overread it
This is a model using US costs; it does not show the result transfers to other health systems.
The statistics, in plain English
An incremental cost-effectiveness ratio of $12,820 per QALY means each extra year of good health gained cost about that much. Small per-person gains still add up when the test is cheap and the treatment is curative.
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