HIQA advises Minister for Health to introduce birth cohort testing for Hepatitis C virus
The Health Information and Quality Authority (HIQA) has published a Health Technology Assessment (HTA) recommending the introduction of once-off testing for the Hepatitis C virus (HCV) to people in Ireland born between 1965 and 1985.
HIQA has advised the Minister for Health that implementation of a birth cohort testing programme would be cost-effective and help Ireland achieve its HCV elimination goals. Following a public consultation, the HTA of birth cohort testing for hepatitis C was approved by the Board of HIQA and has been submitted to the Minister for Health for his consideration.
In Ireland, the prevalence of HCV infection is highest amongst those born between 1965 and 1985. Of the 1.5 million people in this cohort, it is estimated that one in every 100 may have chronic HCV infection. HIQA concluded that offering testing to this group would represent good value for money, but that due to the number of individuals involved, testing would have significant upfront costs. HIQA noted that an initial pilot programme would be beneficial to confirm the prevalence estimates and to address issues concerning the feasibility of the programme before rolling it out nationally.
Dr Máirín Ryan, HIQA’s Deputy CEO and Director of Health Technology Assessment, said: “Chronic HCV infection is frequently called the ‘silent disease’, as many people do not have symptoms and don’t realise that they are infected. However, the damage it does is not silent. If left untreated, chronic HCV infection can cause severe damage to the liver and other organs. For example, 128 liver transplants completed in Ireland between 2005 and 2018 were due to HCV.”
Dr Ryan continued “From reviewing the evidence, we found that the tests available to diagnose chronic HCV infection are highly accurate. Furthermore, the treatments are safe and effective, with over 95% of people treated being cured of their infection.”
Countries globally are setting targets to eliminate viral hepatitis as a public health threat. In Ireland, the Health Service Executive (HSE) aims to achieve the World Health Organization’s target of making Hepatitis C a rare disease before 2030.
You can read the report from the link at the top of the page
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Notes to the Editor:
- The health technology assessment (HTA) of birth cohort testing for hepatitis C can be read at www.hiqa.ie
- HIQA agreed to undertake the HTA which was identified in the 2017 National Clinical Guideline for Hepatitis C Screening. The guideline which was endorsed by the Minister for Health conditionally recommended birth cohort testing for people born between 1965 and 1985. Birth cohort testing is when everyone born between two fixed dates is offered testing for a disease or illness. In Ireland, chronic HCV infection is most common in people born between 1965 and 1985.
- HCV is a blood-borne virus. Between 55 and 85 people out of every 100 ever infected with HCV will develop chronic HCV infection. Chronic HCV infection progresses slowly and can take decades for symptoms to show.
- Ireland currently provides a risk-based approach to testing for HCV. Major risk factors include a history of injecting unprescribed or illicit drugs and needle stick injuries. The introduction of birth cohort testing would not impact access to existing risk-based approaches for detecting hepatitis C infection or the treatment of people identified through risk-based testing.
- Infection with HCV has been a notifiable disease in Ireland since 2004. From 2004 to 2018, a total of 15,266 HCV cases were notified to the Health Protection Surveillance Centre (HPSC). Of these, 71% (n=10,862) were from the 1965 to 1985 birth cohort. However, it is estimated that there are approximately 12,000 people with undiagnosed chronic HCV infection in this birth cohort. There are approximately 1.5 million born between 1965 and 1985.
- Diagnosis of chronic HCV infection involves two steps (based on highly accurate diagnostic tests):
- detection of anti-HCV antibody to indicate if a person has ever been infected with HCV (at least six months after potential exposure to HCV)
- if the antibody test is positive, a supplementary nucleic acid amplification test or core antigen test to determine active (chronic) infection.
- Oral fixed-dose combination tablets of direct-acting antivirals (DAAs) to treat chronic active HCV infection are licensed in Ireland and reimbursed through the HSE’s National Hepatitis C Treatment Programme. DAAs have been shown to be safe, effective and well-tolerated. The treatment course is typically for 8-12 weeks and it is estimated that drug treatment eliminates HCV in over 95 of every 100 people treated. However, treatment cannot reverse severe damage already caused to the liver, so early identification and treatment of individuals is important.
- An economic model was developed to estimate the costs and consequences of implementing a birth cohort testing programme over a lifetime time horizon. A systematic birth cohort testing programme, staggered over a four-year period, was found to be cost-effective. Implementing a systematic birth cohort testing programme was estimated to cost €65 million over a five-year period. However, subsequent costs would be minimal and the programme would ultimately be cost-saving as treatment for the complications of chronic HCV infection will be avoided.