We aimed to determine the optimal testing strategy to identify children with perinatally acquired hepatitis C virus (HCV) infection.
We used a decision-tree framework with a Markov disease progression model to conduct an economic analysis of four strategies, based on combinations of type and timing of test: Anti-HCV with reflex to HCV RNA at 18 months among children known to be perinatally exposed (ie, baseline comparison strategy); HCV RNA testing at 2–6 months among infants known to be perinatally exposed (Test Strategy 1); universal anti-HCV with reflex to HCV RNA at 18 months among all children (Test Strategy 2); universal HCV RNA testing at 2–6 months among all infants (Test Strategy 3). We estimated total cost, quality-adjusted life years (QALYs), and disease sequalae for each strategy.
Each of the three alternative testing strategies resulted in an increased number of children tested and improved health outcomes. HCV RNA testing at 2–6 months (Test Strategy 1) was cost-saving and resulted in a population-level difference in cost of $469,671. The two universal testing strategies resulted in an increase in QALYs and an increase in total costs.
Testing of perinatally exposed infants at age 2–6 months with a single HCV RNA test will reduce costs and improve health outcomes, preventing morbidity and mortality associated with complications from perinatal HCV infections.