Expanding Hepatitis C Testing to All Adults Is Cost-Effective and Improves OutcomesDecember 31, 1969
Expanding Hepatitis C Testing to All Adults Is Cost-Effective and Improves Outcomes
Findings could be considered for future Centers for Disease Control and Prevention recommendations
(Boston) – According to a new study, screening all adults for hepatitis C (HCV) is a cost-effective way to improve clinical outcomes of HCV and identify more infected people compared to current recommendations. Using a simulation model, researchers from Boston Medical Center, Massachusetts General Hospital (MGH) and Stanford University found that this expanded screening would increase life expectancy and quality of life while remaining cost-effective.
The Centers for Disease Control and Prevention (CDC) currently recommends HCV testing for people born between 1945 and 1965, the highest risk population in the U.S. However, recent trends have shown a higher incidence rate of HCV among young people. To address this gap in testing, the researchers created simulations to estimate the effectiveness of HCV testing strategies among different age groups. They compared effects of the current testing recommendations; of testing people over 40 years old or over 30 years old, and of testing all adults over 18 years old. All strategies included the current recommendations for targeted testing of high-risk individuals, such as people who inject drugs.
The study found that screening all adults for would identify more than 250,000 additional people with HCV, increase cure rates from 41 to 61 percent, and reduce death rates for HCV-attributable diseases more than 20 percent, compared with current recommendations.
“When we expanded testing, the results were compelling,” says Joshua Barocas, MD, lead author on the study, an infectious disease physician at MGH and an instructor in medicine at Harvard Medical School. “Changing the current recommendations could have a major public health impact, improving the quality of life for young people with HCV, and reducing death rates.”
The research team used data from national databases, clinical trials, and observational cohorts to inform their simulation models, which took into account the same demographics and HCV epidemiology of the U.S. population.
All of the age-based strategies decreased costs related to managing chronic HCV and advanced liver disease, but the strategy of testing all adults was most effective. Even in a simulated scenario that required twice as much testing among uninfected people to identify the same number of HCV cases, the testing-all-adults strategy remained cost-effective.
“Testing all adults would lead to earlier diagnosis and treatment for many people, which would help to prevent cirrhosis and other long-term complications,” says Joshua Salomon, PhD, co-senior author of the study and professor of medicine at Stanford University. “Overall, when you consider both the better health outcomes and the reduced costs of managing long-term liver disease, expanded testing offers excellent value for money.”
Researchers say these findings should be considered by the CDC for future recommendations on HCV testing.
“Due in part to the opioid epidemic and the increase in injection drug use, the country has seen an increase in cases of HCV among young people,” says Benjamin Linas, MD, co-senior author of the study and infectious disease physician at BMC and an associate professor of medicine at Boston University School of Medicine. “The CDC could address this public health concern by recommending all adults receive a one-time HCV test.”
The study was published online in Clinical Infectious Diseases and was funded by the National Institute on Drug Abuse at the National Institutes of Health, the MGH Fund of Medical Delivery and the U.S. Centers for Disease Control and Prevention.
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About Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $900 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2017 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals."
A New Strategy to Address the Opioid Epidemic: Collaborations between Public Safety and Public Health AgenciesDecember 31, 1969
A New Strategy to Address the Opioid Epidemic: Collaborations between Public Safety and Public Health Agencies
Boston Medical Center, Social Science Research and Evaluation, Inc., and the Massachusetts Department of Public Health found four types of collaborative programs have emerged
(Boston) - A new study shows that public health and public safety agencies established local, collaborative programs in Massachusetts to connect overdose survivors and their personal networks with addiction treatment, harm reduction, and other community support services following a non-fatal overdose. The study, published online in the, is the first of its kind to attempt to systematically document this emerging approach to combating the opioid epidemic.
From December 2015 to January 2016, Department of Public Health researchers reached out to all 351 communities in the state and surveyed public safety agencies (police, firefighters,). They received responses from the police and fire personnel from 31 percent of the communities in Massachusetts. Of those respondents, 21 percent were actively engaged in implementing collaborative programs and outreach in the community to connect overdose survivors with support and treatment services.
“This study identified four different approaches to conducting post-overdose outreach at the community level leveraging existing infrastructure,” said Alex Walley, MD, MSc, an addiction medicine specialist at Boston Medical Center’s Grayken Center for Addiction and senior author of the study. “We described innovative public health and public safety partnerships that reach a particularly high risk population – those who survive an overdose.”
The four types of programs in Massachusetts included multidisciplinary team visits, in which a public safety (police, fire, EMS) and one or more public health representatives travel together to the residence of the overdose survivor or site of an overdose shortly following the event. In addition, police visits with referrals were similarly structured, with officers providing information on support group schedules and addiction treatment options to individuals, and even direct referrals to partnering programs, if the survivor was ready to accept services.
Clinicians were also embedded within a police department or employed at a collaborating social service or addiction treatment program who received the contact information for overdose survivors or a member of their personal network. The last group of programs noted, location-based outreach, encouraged overdose survivors, people with an opioid use disorder, and family or associates to visit a community-based site to obtain information, resources, and/or access to services. Of the programs that were interviewed, most were less than a year old at the time of the study, and roughly half were developed by an influential police or fire chief. Nine of Massachusetts’ 14 counties had respondents who were interviewed for the study.
The expansion of these programs could save lives, according to the researchers, and their structures are capable of being scaled into other communities for a larger and broader impact.
“Our goal here was to advance the field by increasing awareness of these new innovative collaborations, raise issues that those seeking to adopt and implement these models should consider, and highlight the need for further research into their effectiveness and potential to save lives,” said Scott Formica, senior research scientist with Social Science Research and Evaluation, Inc. and the study’s first author.
Public safety officials reported that stigma within their agencies and communities, lack of funding, and long-term sustainability were barriers to implementing programs. If these public safety and public health partnerships are found to be effective, they have the potential to increase engagement across the country with social service and addiction treatment systems by those who are at elevated risk for experiencing a fatal opioid overdose.
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