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Cost-Effectiveness of Point-of-Care Hepatitis C Virus RNA Testing in the US
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March 2026
Abstract
Importance The standard of care (SOC) laboratory-based hepatitis C virus (HCV) diagnostic algorithm is associated with high rates of undiagnosed cases, patients lost to follow-up, and low rates of treatment initiation, particularly among high-risk populations. Improving diagnostic efficiency is critical for HCV elimination.
Objective To evaluate the cost-effectiveness of a point-of-care (POC) HCV RNA-first diagnostic strategy compared with SOC across care settings in the US serving people at high-risk of HCV infection.
Design, Setting, and Participants This economic evaluation used a hybrid decision tree and HCV transmission model using real-world claims data and published literature. The model projected clinical and economic outcomes over 1-year and lifetime horizons. Hypothetical cohorts of individuals eligible for HCV testing were modeled in each of 4 care settings-community health centers, emergency departments, harm reduction clinics, and mobile outreach or street medicine programs in the US-and assumed to be primarily people who inject drugs.
Exposure POC HCV RNA-first testing vs SOC laboratory-based HCV antibody and reflex confirmatory RNA testing.
Main Outcomes and Measures The primary outcomes were rates of HCV diagnosis, linkage to care, treatment initiation, sustained virologic response at week 12 after treatment, forward transmission, long-term complications, costs, and incremental cost-effectiveness ratios. One-way and probabilistic sensitivity analyses assessed the impact of uncertainty on results.
Results Among modeled cohorts, POC HCV RNA-first testing identified 93.4% of cases vs up to 68.7% with SOC. POC HCV RNA-first testing increased linkage to care (by 37.6%-73.4%), treatment initiation (by 12.1%-48.9%), and sustained virologic response at week 12 after treatment (by 3.6%-26.4%) across care settings. Forward transmission was reduced by 16.3% to 53.3%. Initial costs were higher in some settings, but lifetime costs were lower, with savings of $3387 per person tested. The POC HCV RNA-first strategy was dominant (lower costs and improved outcomes) over SOC across all settings analyzed.
Conclusions and Relevance In this economic analysis of HCV testing strategies, a POC HCV RNA-first approach was found to be cost-effective and clinically optimal for high-risk populations, and may represent a critical component of HCV elimination efforts in the US.
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