Integrating viral hepatitis management into the emergency department: A further step towards viral hepatitis elimination.

Background & Aims

Many people with HCV and HBV infection are unaware of their condition, particularly at-risk and vulnerable populations who face barriers for screening and linkage to care. Emergency departments are often their only point of contact with the health system.

Methods

This is a prospective study investigating HBsAg and HCV antibody testing, with reflex testing for HDV antibodies and HCV RNA, in adults attending an emergency department and requiring a blood test. Positive cases were linked to care. A cost-effectiveness analysis was performed.

Results

From February 2020 to February 2022, a total of 17,560 individuals were screened. HBsAg was detected in 91 (0.5%), HCV RNA in 128 (0.7%), and HDV antibodies in two (0.01%) individuals. Nearly 40% of positive cases were unaware of their condition. Linkage to care was achieved in 42 of 56 HBsAg-positive and 45 of 69 HCV RNA-positive participants who were candidates for referral. HCV and HBV screening

Conclusions

On emergency department screening for hepatitis B, C, and D in Barcelona, the prevalence of HBsAg was 0.5% and HCV RNA 0.7%, approximately threefold higher than that observed in the general population. This strategy diagnosed patients with active HCV infection and no risk factors, who would not have been screened according to the current recommendations. Screening and linkage to care of viral hepatitis is cost-effective in this setting.

Impact and implications

We evaluated the performance and cost-effectiveness of a viral hepatitis screening programme implemented in an emergency department, which aimed to identify and link to care people living with hepatitis B and C. Our findings reveal a threefold higher prevalence of hepatitis B and C than in the general Spanish population, possibly attributable to the role of the emergency department as the main healthcare gateway for vulnerable populations, who have a higher prevalence of viral hepatitis. Risk factors for viral hepatitis could not be identified in most people living with hepatitis B and C attending the emergency department; hence, screening beyond risk factors should be considered in hepatitis detection strategies. Emergency department screening is cost-effective for hepatitis C and is a cost-saving strategy for hepatitis B in our setting. These data should inform future updates to clinical guidelines.

Informations de copyright

© 2023 The Authors.

Déclaration de conflit d'intérêts

JL has served as a speaker for Gilead and Pfizer. JCR has served as a speaker for and has received travel grants from Gilead. RDH is an employee of Pharmacoeconomics & Outcomes Research Iberia, a consultancy firm that has received unconditional funding from Gilead Sciences. FRF is a consultant, advisor, and speaker for Gilead. MAC is an employee of Pharmacoeconomics & Outcomes Research Iberia, a consultancy firm that has received unconditional funding from Gilead Sciences. MRB has received research educational and travel grants from Gilead and has served as a speaker for Gilead and GSK. RE has served as a speaker and advisor for Gilead and Abbvie. MB has served as a speaker and advisor for Gilead and Abbvie. All other authors declare no competing interests. Please refer to the accompanying ICMJE disclosure forms for further details.