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Mandatory applicant screening may reduce HCV, costs in the military
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Implementing a mandatory applicant screening program could reduce hepatitis C virus infection in members of the military and lead to overall cost savings for the Department of Defense, according to data published in Hepatology.
“We undertook a contemporary assessment of hepatitis C in recently deployed military forces ... with the aims of decreasing the burden of HCV in military personnel, decreasing the threat posed by HCV-infected personnel deployed to combat operations who may enter emergent non-FDA blood supply and improving health outcomes for individuals through earlier diagnosis and linkage to care,” David M. Brett-Major, IDD, NMRC, from the Uniformed Services University, Maryland, and colleagues wrote.
By evaluating serum, the researchers determined the HCV infection status of 10,000 Army, Navy, Marine Corps and Air Force service members deployed to Iraq and Afghanistan between 2007 and 2010. Researchers then built “a cost model from the perspective of the Department of Defense for a military applicant screening program,” they wrote.
Of the personnel, 9,997 were included in the final analysis. This group was separated into two cohorts: those born before 1966 (n = 773) and those born after 1965 (n = 9,224).
Overall, 23 chronic cases of HCV were observed among members most recently tested. Of these, 18 already had HCV at military accession. In the older cohort, nine cases of chronic HCV were present.
Among military personnel born after 1965, the prevalence of HCV antibody-positive participants was 0.98/1,000 (95% CI, 0.45-1.85) at accession and 0.43/1,000 (95% CI, 0.12-1.11) for chronic HCV. Among these military personnel, service-related HCV incidence was low, with 64% of infections being present at the time of accession.
Service members with HCV at accession were older compared with those without HCV at accession (P < .05).
Without HCV screening, the cost to the Department of Defense for treating an estimated 93 cases of chronic HCV from a 1-year accession cohort was $9.3 million. Screening with an enzyme immunoassay (EIA) followed by a nucleic acid test (NAT) for confirmation showed an annual savings and a $3.1 million advantage over not screening. Screening with EIA alone cost $3.5 million.
“Screening with HCV EIA alone would identify 91 of the 93 cases of chronic HCV infection among the applicant population who acceded, which would result in a treatment cost avoided of $9.1 million,” the researchers wrote.
The combination of EIA and NAT adds a small incremental cost of $0.045 million when using a NAT-screening strategy administered only to a small number of members with EIA screening results, according to the research.
“The use of confirmatory testing is important in stratifying risk and treatment decisions in individual patients, as discussed in clinical guidelines,” the researchers wrote.
Brett-Major and colleagues concluded: “An applicant screening program will also markedly reduce the burden of chronic HCV infection in the overall force, will result in a small system costs savings of approximately $3 million per year due to decreases in treatment costs to the military health care system, will decrease the threat of transfusion-transmitted HCV infection in the emergent battlefield non-FDA blood supply posed by HCV-infected personal and may provide an opportunity for individuals with chronic HCV infection to obtain earlier diagnosis and linkage to care and treatment.” – by Melinda Stevens
- Reference:
- Brett-Major DM, et al. Hepatology. 2015; doi: 10.1002/hep.28303.
Disclosure: Brett-Major reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.