Hepatitis C Management at Federally Qualified Health Centers during the Opioid Epidemic: A Cost-Effectiveness Study

ABSTRACT Background The opioid epidemic has been associated with an increase in hepatitis C virus (HCV) infections. Federally qualified health centers (FQHCs) have a high burden of hepatitis C disease and could serve as venues to enhance testing and treatment. Methods We estimated clinical outcomes and the cost-effectiveness of hepatitis C testing and treatment at US FQHCs using individual-based simulation modeling. We used individual-level data from 57 FQHCs to model 9 strategies including permutations of HCV antibody testing modality, person initiating testing and testing approach. Outcomes included life expectancy, quality adjusted life years (QALY), hepatitis C cases identified, treated and cured, and incremental cost-effectiveness ratios (ICERs). Results Compared to current practice (risk-based with laboratory-based testing), routine rapid point-of-care testing initiated and performed by a counselor identified 68% more cases after (non-reflex) RNA testing in the first month of the intervention, led to a 17% reduction in cirrhosis cases, and a 22% reduction in liver deaths among those with cirrhosis over a lifetime. Routine rapid testing initiated by a counselor or a clinician provided better outcomes at either lower total cost or at lower cost per QALY gained, when compared to all other strategies. Findings were most influenced by the proportion of patients informed of their anti-HCV test results. Conclusions Routine anti-HCV testing followed by prompt RNA testing for positives is recommended at FQHCs to identify infections. If using dedicated staff or point-of-care testing is not feasible, then measures to improve immediate patient knowledge of antibody status should be considered.