The Health Information and Quality Authority (HIQA) has commenced work on a health technology assessment (HTA) of offering testing for the hepatitis C virus to people in Ireland born between 1965 and 1985.

The aim of the HTA is to establish the clinical- and cost-effectiveness of birth cohort testing for hepatitis C in Ireland. In addition, the assessment will estimate the budget impact of introducing a birth cohort testing programme and assess the organisational and resource implications of such a service. The HTA is scheduled to be finalised in early 2020.

The outcome of this assessment will be provided as advice to the Minister for Health to inform a decision on whether or not to provide birth cohort testing for hepatitis C in Ireland.

Birth cohort testing involves offering one-time testing for the hepatitis C virus to people born during a particular period of time. Compared with risk-based testing, this type of testing avoids the need to identify specific behavioural risks as the basis for testing. Birth cohort testing is conditionally recommended by the World Health Organization in easily-identified age or other demographic groups known to have a prevalence higher than that of the general population.

The 1965 to 1985 birth cohort was identified based on national data, which indicated that the prevalence of hepatitis C infection in Ireland is highest amongst those born between 1965 and 1985 (72.5% of cases).

HIQA’s Director of Health Technology Assessment and Deputy Chief Executive, Dr Máirín Ryan, said: “Hepatitis C is a blood-borne virus that predominantly affects the liver. Although infection can often resolve spontaneously, chronic hepatitis C infection may lead to fibrosis, cirrhosis, liver transplantation and potentially fatal complications such as hepatocellular carcinoma.”

Dr Ryan continued: “The progression of hepatitis C-related disease is often slow and unpredictable. Individuals who are chronically infected may only become aware of their infection status following the development of cirrhosis and its complications. With the availability of highly-effective treatment, there is now an opportunity to identify and cure people living with chronic hepatitis C infection that are currently undiagnosed.”

HIQA has established an expert advisory group comprising representatives from key stakeholder groups who will advise the HTA evaluation team during the course of this assessment.

Ends.

Further Information:
Clare O’Byrne, Communications and Stakeholder Engagement, HIQA
01 8286712 / 085 8030846, cobyrne@hiqa.ie  

Notes to the editor:

• Health technology assessment (HTA) is a multidisciplinary research process that collects and summarises information about a health technology. The information can cover a range of fields, including clinical effectiveness and safety, cost effectiveness and budget impact, organisational and social aspects, and ethical and legal issues.
• The term ‘health technology’ encompasses a wide range of health interventions. ‘Technology’ includes any intervention that may be used to promote health to prevent, diagnose or treat a disease; or in rehabilitation or long-term care.
• HIQA agreed to undertake the HTA following the publication of the National Clinical Effectiveness Committee’s National Clinical Guideline for Hepatitis C Screening. The National Clinical Guideline was endorsed by the Minister for Health in 2017.
• The National Clinical Guideline for Hepatitis C Screening conditionally recommended offering one-off hepatitis C virus (HCV) testing to people in Ireland born between 1965 and 1985 subject to the outcome of a full HTA.
• A birth cohort is identified based on evidence of an elevated risk of exposure relative to the general population. The higher risk of hepatitis C infection may be because of historical exposure to a risk factor that has since been removed, such as by the introduction of routine screening of blood products and improvements in injection safety practices.
• In 2018, there were 589 new HCV infection notifications in Ireland, representing a notification rate of 12.4 per 100,000 population. Of these, 361 (61%) were from the 1965 to 1985 birth cohort.
• Overall, it is estimated that the total number of people with chronic HCV infection in Ireland is approximately 20,800.
• Diagnosis of chronic HCV infection involves two steps: (1) detection of anti-HCV antibody to indicate if a person has ever had acute HCV infection, and (2) a supplementary nucleic acid test or core antigen test to confirm active infection.  
• All blood and organ donations in Ireland are routinely tested for HCV infection. Individuals undergoing haemodialysis also receive routine testing.
• HCV testing is offered to those identified to be at risk of infection, such as people who ever injected drugs, prisoners or former prisoners, and homeless people who have a history of engaging in risk behaviours associated with HCV transmission.
• The National Hepatitis C Treatment Programme was established in 2015 to provide treatment across a range of healthcare settings to all people living with chronic HCV infection with the aim of making it a rare disease in Ireland by 2026.
• Curative therapy for HCV infection, in the form of direct-acting antivirals (DAAs), is available through the National Hepatitis C Treatment Programme. DAA drug combinations are generally prescribed for daily oral consumption for 8-12 weeks, but treatment may last up to 24 weeks.
• The US Centers for Disease Control and Prevention and the US Preventive Services Task Force have recommended birth cohort testing. Testing of adults born between 1945 and 1965, based on prevalence estimates for the US population, was recommended by both entities.