Study Supports HCV RNA Test at Age 2-6 Months for Perinatally Exposed Infants

Testing infants known to be perinatally exposed to hepatitis C at 2 to 6 months of age with a single HCV RNA test would reduce costs and improve health outcomes, according to a recent study.

The study, published in the Journal of Pediatrics, evaluated 4 testing strategies using a decision-tree framework with a Markov disease progression model to estimate cost, quality-adjusted life years and disease sequelae.

The strategies included in the study were:

1. HCV RNA testing at 2-6 months among infants known to be perinatally exposed
2. Universal anti-HCV with reflex to HCV RNA at 18 months among all children
3. Universal HCV RNA testing at 2-6 months among all infants
4. The baseline comparison strategy of anti-HCV with reflex to HCV RNA at 18 months among children known to be perinatally exposed

“All 3 comparison strategies resulted in more children tested and better population-level health outcomes, including fewer cases of hepatocellular carcinoma, decompensated cirrhosis, liver transplants, and HCV-related deaths, compared with the currently accepted standard of anti-HCV testing at age 18 months or older,” the study authors, led by Eric W. Hall, PhD, an epidemiologist at Oregon Health & Science University-Portland State University School of Public Health, wrote.

While the universal testing strategies resulted in improved health outcomes, they also resulted in increased population-level costs, amounting to $38 million for testing strategy 2 and $129 million for testing strategy 3 when compared with the baseline strategy. Testing strategy 1 resulted in $469,671 in cost savings.

“These analyses indicate the optimal timing and most efficient test is a single HCV RNA during age 2-6 months among children perinatally exposed to HCV,” the authors wrote. “Factors driving these results include pediatric loss to follow up, high attendance at well-child visits in the first 6 months of life, and highly sensitive nucleic acid testing with reliable results starting at age 2 months.”

The authors noted that more cases of HCV among perinatally exposed infants will be identified as recommendations updated in 2020 for HCV screening during pregnancy are adopted more widely.

The rate of testing during pregnancy currently is below 50%. The study determined that at that rate, the cost of universal anti-HCV testing at 18 months is $142,764 per infection diagnosed, and HCV RNA testing at 2-6 months is $187,561 per infection diagnosed. As testing during pregnancy increases, the return for universal testing diminishes, with costs per infection diagnosed, reaching as high as $705,403 for anti-HCV testing, and $273,813 for HCV RNA testing.

Infants exposed to HCV are more likely to be publicly insured, involved in the foster care system and have other factors putting them at risk of losing connection to follow-up care. Testing early allows providers to identify HCV cases among infants who may not attend later well-care visits.

Limitations of the study include that infant follow-up inputs were based on a single study, potential costs and benefits associated with the parent weren’t considered, it assumed that children wouldn’t be diagnosed and treated later in life, and it assumed treatment beginning at age 3.