HCV self-testing: Bridging screening gaps and ensuring cost-effectiveness for both high-risk and universal populations: Correspondence to editorial on “Self-testing strategy to eliminate hepatitis C as per World Health Organization’s goal: Analysis of dis Gyeongseon Shin, Beom Kyung Kim, SeungJin Bae, Hankil Lee, Sang Hoon Ahn Clinical and Molecular Hepatology.2025; 31(2): e163. CrossRef
Background/Aims The World Health Organization (WHO) aims to eliminate hepatitis C virus (HCV) by 2030; therefore, widespread HCV screening is required. The WHO recommends HCV self-testing (HCVST) as a new approach. We aimed to evaluate disease burden reduction using the HCVST screening strategy and identify the most cost-effective approach.
Methods We developed a dynamic open-cohort Markov model to assess the long-term effects and costeffectiveness of HCVST in the Republic of Korea from 2024 to 2030. Strategies for comparison included universal, birth cohort, high-risk group screening, and no screening, focusing on the following: (1) incremental costeffectiveness ratio (ICER) per disability-adjusted life-year (DALY) saved; (2) severe liver disease cases; and (3) liverrelated death reduction.
Results Universal HCVST screening is the most effective strategy for achieving the WHO goal by 2030, substantially lowering the incidence of severe liver disease by 71% and preventing liver-related deaths by 69%, thereby averting 267,942 DALYs. Moreover, with an ICER of US$8,078 per DALY and high cost-effectiveness, the sensitivity results prove that cost-effectiveness is robust. Although high-risk group screening offers the lowest cost compared with other strategies, its effectiveness in preventing severe liver disease is minimal, falling short of the current WHO goal.
Conclusions Our study confirms that universal HCVST screening is a cost-effective strategy aligned with the WHO goal to eliminate HCV by 2030. Despite its higher costs compared to risk-based screening, the disease burden can be significantly reduced by providing effective HCVST access to individuals who might otherwise not be tested.
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Universal self-testing as a cost-effective weapon to eliminate hepatitis C virus in the Republic of Korea: Editorial on “Self-testing strategy to eliminate hepatitis C as per World Health Organization’s goal: Analysis of disease burden and cost-effectiven Eun Sun Jang Clinical and Molecular Hepatology.2025; 31(2): 596. CrossRef
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Chang Hun Lee, Gwang Hyeon Choi, Hwa Young Choi, Sojung Han, Eun Sun Jang, Young Eun Chon, Young Chang, Kyung-Ah Kim, Do Young Kim, Hyung Joon Yim, Hye-Lin Kim, Sook-Hyang Jeong, In Hee Kim
Clin Mol Hepatol 2023;29(3):779-793. Published online May 15, 2023
Background/Aims To eliminate hepatitis B virus (HBV) and hepatitis C virus (HCV) according to the World Health Organization (WHO) criteria in 2021, this study investigated the national core indicators representing the current status of viral hepatitis B and C in South Korea.
Methods We analyzed the incidence, linkage-to-care, treatment, and mortality rates of HBV and HCV infection using the integrated nationwide big data of South Korea.
Results According to data from 2018–2020, the incidence of acute HBV infection in South Korea was 0.71 cases per 100,000 population; tthe linkage-to-care rate was only 39.4%. Among those who need hepatitis B treatment, the treatment rate was 67.3%, which was less than 80% reported in the WHO program index. The annual liver-related mortality due to HBV was 18.85 cases per 100,000 population, exceeding the WHO target of four; the most frequent cause of death was liver cancer (54.1%). The annual incidence of newly diagnosed HCV infection was 11.9 cases per 100,000 population, which was higher than the WHO impact target of five. Among HCV-infected patients, the linkage-to-care rate was 65.5% while the treatment rate was 56.8%, which were below the targets of 90% and 80%, respectively. The liver-related annual mortality rate due to HCV infection was 2.02 cases per 100,000 population.
Conclusions Many of the current indicators identified in the Korean population did not satisfy the WHO criteria for validation of viral hepatitis elimination. Hence, a comprehensive national strategy should be urgently developed with continuous monitoring of the targets in South Korea.
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Background/Aims Cirrhosis is the most important risk factor of hepatocellular carcinoma (HCC), and patients with cirrhosis are recommended to receive semiannual surveillance for early HCC detection. However, early cirrhosis is often asymptomatic and can go undiagnosed for years, leading to underuse of HCC surveillance in clinical practice. We characterized the frequency and associated factors of unrecognized cirrhosis in a national sample of patients with HCC from the United States.
Methods HCC patients aged 68 years and older, diagnosed during 2011 to 2015 were included from the SEERMedicare Linked Database. If cirrhosis was diagnosed within 6 months immediately preceding HCC diagnosis or after HCC diagnosis, cases were categorized as unrecognized cirrhosis. Factors associated with unrecognized cirrhosis were identified using logistic regression analyses. Factors associated with overall survival were evaluated using Cox regression analyses.
Results Among 5,098 HCC patients, 74.8% patients had cirrhosis. Among those with cirrhosis, 57.4% had unrecognized cirrhosis, with the highest proportion (76.3%) among those with NAFLD-related HCC. Male sex (aOR: 2.12, 95% CI: 1.83–2.46), non-Hispanic Black race (aOR: 1.93, 95% CI: 1.45–2.57), and NAFLD etiology (aOR: 4.46, 95% CI: 3.68–5.41) were associated with having unrecognized cirrhosis. Among NAFLD-related HCC patients, male sex (aOR: 2.32, 95% CI: 1.71–3.14) was associated with unrecognized cirrhosis. Unrecognized cirrhosis was independently associated with worse overall survival (aHR: 1.17, 95% CI: 1.08–1.27) compared to recognized cirrhosis.
Conclusions Unrecognized cirrhosis is common in NAFLD-related HCC, particularly among male and Black patients, highlighting these groups as important intervention targets to improve HCC surveillance uptake and outcomes.
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Hepatitis C virus (HCV) infection is the second most common cause of chronic liver disease in South Korea, with a prevalence ranging from 0.6% to 0.8%, and HCV infection incidence increases with age. The anti-HCV antibody test, which is cheaper than the HCV RNA assay, is widely used to screen for HCV infections; however, the underdiagnosis of HCV is a major barrier to the elimination of HCV infections. Although several risk factors have been associated with HCV infections, including intravenous drug use, blood transfusions, and hemodialysis, most patients with HCV infections present with no identifiable risk factors. Universal screening for HCV in adults has been suggested to improve the detection of HCV infections. We reviewed the cost-effectiveness of HCV screening and the methodologies used to perform screening. Recent studies have suggested that universal HCV screening and treatment using direct-acting antivirals represent cost-effective approaches to the prevention and treatment of HCV infection. However, the optimal timing and frequency of HCV screening remain unclear, and further studies are necessary to determine the best approaches for the elimination of HCV infections.
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Background/Aims This study aimed to evaluate the cost-effectiveness of hepatitis C virus (HCV) screening compared to no screening in the Korean population from societal and healthcare system perspectives.
Methods A published decision-tree plus Markov model was used to compare the expected costs and quality-adjusted life years (QALY) between one-time universal HCV screening and no screening in the population aged 40–65 years using the National Health Examination (NHE) program. Input parameters were obtained from analyses of the National Health Insurance claims data, Korean HCV cohort data, or from the literature review. The population aged 40–65 years was simulated in a model spanning a lifetime from both the healthcare system and societal perspectives, which included the cost of productivity loss due to HCV-related deaths. The incremental cost-effectiveness ratio (ICER) between universal screening and no screening was estimated.
Results The HCV screening strategy had an ICER of $2,666/QALY and $431/QALY from the healthcare system and societal perspectives, respectively. Both ICERs were far less than the willingness-to-pay threshold of $25,000/QALY, showing that universal screening was highly cost-effective compared to no screening. In various sensitivity analyses, the most influential parameters on cost-effectiveness were the antibodies to HCV (anti-HCV) prevalence, screening costs, and treatment acceptance; however, all ICERs were consistently less than the threshold. If the anti-HCV prevalence was over 0.18%, screening could be cost-effective.
Conclusions One-time universal HCV screening in the Korean population aged 40–65 years using NHE program would be highly cost-effective from both healthcare system and societal perspectives.
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Ki Jun Song, M.S.*, Yong Han Paik, M.D., Chang Hwan Choi, M.D., Hyun Woong Lee, M.D.,
Young Soo Park, M.D., Chae Yoon Chon, M.D., and Young Myoung Moon, M.D.,
Background / Aim : We identified risk factors for hepatocellular carcinoma(HCC)through a nine-year follow-up study, ending last year, of 4,339 patients with chronic liver disease. The aim of this study was to establish an individual prediction model according to risk factors for the development of HCC. Methods : We studied a total of 1994 patients who had regular check-ups from January 1990 to December 1998. We analyzed the risk factors and established the individual prediction model to predict the risk rate for HCC using logistic regression analysis. We applied the model to patients who were enrolled over the next two years. Results : 90(9.05%) out of 994 patients developed HCC during a mean of 33 months of follow-up. The risk index for individual patients was made by considering the relative risk level of statistically significant risk factors. From 1999 to 2000, 480 patients were newly enrolled and divided into a low risk group(less than 5% probability), an intermediate risk group(5% to 10% probability), and a high risk group(more than 10% probability). According to this classification, 1 of 191 patients in the low risk group(0.523%), 5 of 176 patients intermediate risk group(2.84%), and 21 of 113 patients in the high risk group(18.6%) were diagnosed with HCC. Conclusion : We confirmed the reliability of the newly established individual prediction model for the screening of HCC. This model may help screening programs to be done effectively by focusing on high risk groups for HCC. (Korean J Hepatol 2001;7 :449- 458)
Backgroung/Aims : The prognosis of primary hepatocellular carcinoma is extremely poor because of its large size, portal vein thrpombosis, extrahepatic metastasis and underlying liver cirrhosis. The aim, of this study is to evaluate the usefulness of ultrasound screening test for early detection of hepatocellular carcinoma in high-ridk populations. Methods : We analysed 119 patients who were diagnosed with hepatocellular carcinoma by ultrasonography screening test in Yonsei University Severance Hospital from the period of January 1990 to December 1996. Result : The mean follow-up duration to the diagnosis of hepatocellular carcinoma was 30 months (range 3-75). The number of patients with single lesion was 89(75%). The mean diameter of the tumor was 3.0 cm (range 1-10) , 82 patients (70%) had masses measured less than 3cm in diameter. The Number of patients with elevated serum alphafetoprotein level above 400ng/ml was 29(25%). The median survival was 28 months in screening group, significant compared with 7 months in control group (p<0.001). Conclusions : Ultrasound follow-up in high-ridk group of hepatocellular carcinoma mede it possible to detect small tumors in a high percentage of cases. This may lead to an increase in the number of potentially curable tumors and hence an increase in the overall survival rate. So ultrasound screening test is important in the high-ridk group of hepatocellular carcinoma. ( Korean J Hepatol 1998;4:330-345)
Background/Aims Transfection of the hepatitis B virus (HBV) genome requires the cloning of tandem HBV sequences inserted into a plasmid vector, which is usually screened for by the restriction enzyme digestion of plasmid minipreparation from at least a dozen of bacterial colonies. The aim of this study was to develop a simple alternative screening method for bacterial colonies harbouring tandem HBV sequences by a PCR. Methods: A set of polymerase chain reaction (PCR) primer was designed to detect the bacterial colonies harbouring "head to tail" dimeric HBV DNA. PCR which amplifies the head to tail junction site of two tandem HBV molecules was performed. Results: PCR products with appropriate size (1.2kb) were obtained. The accurate detection by PCR screening technique was confirmed by enzyme digestion. Conclusions: These results suggest that PCR screening technique is a simple and rapid method for the identification of bacterial colonies containing tandem HBV sequences. (Korean J Hepatol 1999;5:184－189)
Background/Aims Screening for hepatocellular carcinoma (HCC) is a common practice in the endemic countries but its exact role has not been fully investigated. The purpose of this study was to determine whether screening can achieve early diagnosis and survival benefits. Methods: All HCC patients diagnosed at our hospital (September 1994∼April 2000) were enrolled; They were divided into two groups; a pre- screening group screened with alpha-fetoprotein and ultrasound for longer than 6 months before diagnosis and a non pre-screening group. We compared the tumor size, portal vein thrombosis, and stage at initial diagnosis and survival rate between the two groups. Results: A total of 247 patients were enrolled. 64 were in the non pre-screening group and 183 were in the non pre-screening group. The tumor size at initial diagnosis in the pre-screening group was smaller than in the non pre-screening group (2.6±2.0 cm vs. 5.7±4.1 cm, p<0.05). The percentages of patients with stage I, II, III, and IV were 42.2%, 20.3%, 14.1%, 23.4% in the pre-screening group and 8.7%, 19.7%, 36.6%, 35.0% in the non pre-screening group. A significantly higher proportion in the pre-screening group had earlier stage compared with the non pre-screening group (p<0.05). Portal vein thrombosis in the pre-screening group was noticed as significantly less than in the non pre-screening group (9.4% vs. 26.8%, p<0.05). Among Child A patients, the cumulative survival rate in the pre-screening group was significantly higher than in the non pre-screening group (1 year; 91.4% vs. 70.7%, 2 year; 71.5% vs. 59.9%, p<0.05). Conclusions: Screening with AFP and US is a useful tool for early diagnosis of HCC, especially with improved survival in Child A patients.(Korean J Hepatol 2003;9:116-123)
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