One-Time, Universal Screening for Hepatitis C Is Cost-Effective

Universal 1-time screening for chronic HCV infection is cost-effective compared with no screening or with birth cohort-based screening alone.

Universal 1-time screening for chronic hepatitis C virus (HCV) infection is cost-effective compared with no screening or with birth cohort-based screening alone, according to results published in Clinical Gastroenterology and Hepatology.

The researchers developed a Markov state transition model to estimate the effects of universal 1-time screening of adults age ≥18 years in the United States compared with the effects of the current guideline of screening adults born from 1945 through 1965.

They compared potential outcomes of universal screening or birth cohort screening followed by antiviral treatments for those with HCV infection compared with no screening. The researchers also measured effectiveness with quality-adjusted life years (QALY) and costs with 2017 US dollars.

Compared with no screening, universal 1-time screening of US residents with a general population prevalence of HCV antibody >0.07% cost less than $50,000/QALY.

Compared with 1-time birth cohort screening, universal 1-time screening and treatment cost $11,378/QALY gained.

Not screening is both more expensive and less effective compared with either screening strategy.

The results indicated that compared with birth cohort screening, universal screening was cost-effective when the prevalence of HCV antibody positivity was >0.07% among adults not in the birth cohort.

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“A recommendation for HCV testing of all adults will support the national response to the epidemic of HCV infection among young persons in the United States,” the researchers wrote.


Eckman MH, Ward JW, Sherman KE. Cost effectiveness of universal screening for HCV infection in the era of direct-acting, pangenotypic treatment regimens [published online September 8, 2018]. Clin Gastroenterol Hepatol. doi:10.1016/j.cgh.2018.08.080