Outcomes and costs of single-step hepatitis C testing in primary care, Birmingham, United Kingdom. (January 2019)

• Record Type: Journal Article
• Authors: Munang, M.; Smit, E.; Barnett, T.; Atherton, C.; Tahir, M.; Atabani, S.F.
• Is Part Of: Public health. Volume 166(2019)
• Page Start: 40
• Page End: 44
• Publication Date: 2019-01
• Subjects: Hepatitis C -- Clinical laboratory techniques -- Continuity of patient care -- Quality improvement; Public health -- Periodicals; Public health -- Periodicals; Electronic journals; 362.1
• DOI: 10.1016/j.puhe.2018.09.024
• Languages: English
• ISSNs: 0033-3506

Abstract

Abstract: Objectives: In UK laboratories, the diagnostic algorithm for chronic hepatitis C (HCV) infection commonly requires two serological assays to confirm anti-HCV–antibody positivity in a serum sample followed by HCV RNA detection in a second whole-blood sample (two-step testing algorithm). A single-step algorithm (both anti-HCV antibodies and RNA tested on an initial serum specimen) has been advocated to reduce attrition rates from the care pathway. Study design: To investigate the feasibility, clinical impact and relative costs of switching from a two-step to single-step testing algorithm in the laboratory, a pilot study on unselected primary care requests was undertaken. Methods: All primary care patients tested for HCV infection from December 2013 to April 2016 were included. The single-step testing algorithm was introduced in March 2015. Before this, the two-step algorithm was used. Patients were followed up until August 2016. Results: RNA quantitation in plasma was within one log of serum values for 21 paired samples. Although all patients in the single-step algorithm received an RNA test, only 70% completed the two-step testing algorithm; differences in referral rates to specialist care was due to 30% of HCV antibody–positive patients in the two-step algorithm not having follow-up whole-blood sampling for HCV RNA testing. Costs per new diagnosis and new diagnosis referred to specialist care were lower in single-step testing by £94.32 and £144.25, respectively. Conclusion: This study provides further evidence that a single-step testing algorithm, as recommended in the UK Standards for Microbiology Investigation, works in practice and should be the standard of care for screening for chronic HCV. Highlights: Referral rates for specialist assessment are high upon diagnosis of active HCV infection. 30% of HCV antibody–positive patients fail to return for confirmation of active infection. This attrition rate from missed diagnoses is eliminated by single-step HCV testing. Based on this quality improvement, single-step HCV testing should be the standard of care.