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 disease burden and cost-effectiveness”

Article information

Clin Mol Hepatol. 2025;31(2):e163-e165

Publication date (electronic) : 2024 November 29

doi : https://doi.org/10.3350/cmh.2024.1057

Gyeongseon Shin^1,*, Beom Kyung Kim^2,*, SeungJin Bae¹, Hankil Lee^,1, Sang Hoon Ahn^,2

¹College of Pharmacy, Ewha Womans University, Seoul, Korea

²Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

Corresponding author : Hankil Lee College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 03760, Korea Tel: +82-2-3277-4504, Fax: +82-2-3277-2851, E-mail: hankil@ewha.ac.kr

Sang Hoon Ahn Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1930, Fax: +82-2-393-6884, E-mail: ahnsh@yuhs.ac

*Gyeongseon Shin and Beom Kyung Kim contributed equally to this work.

Editor: Han Ah Lee, Chung-Ang University College of Medicine, Korea

Received 2024 November 23; Accepted 2024 November 26.

Dear Editor,

We are grateful to Jang’s editorial [1] for providing additional new insights to our article entitled, “Self-testing strategy to eliminate Hepatitis C as per World Health Organization (WHO)’s goal: Analysis of disease burden and cost-effectiveness” [2]. Jang highlighted several key points which can guide more effective strategy to eliminate hepatitis C.

HCV self-testing (HCVST) for diagnosis has been recommended by the WHO [3]; however, cost-effectiveness analyses of screening methods so far have predominantly focused on blood testing [4]. Even in high-income countries with well-established national health check-up systems such as the South Korean environment, the participation rate for such programs could not surpass around 70% [1,5]. This indicates that a considerable portion of the population remains unscreened. HCVST can play a pivotal role in bridging this gap by offering a more accessible and convenient alternative. By reaching populations who might otherwise be missed by blood testing programs, HCVST can substantially enhance overall screening coverage.

In our study, we conservatively applied the screening uptake rates observed with blood testing. However, if HCVST were implemented, it is anticipated that higher screening rates could be achieved, leading to greater clinical and economic benefits. Furthermore, South Korea has one of the highest levels of medical accessibility globally, with an average number of 17.5 consultations with medical doctors per person in 2022 [6]. This highlights that even in high-income countries, medical accessibility does not necessarily translate to universal screening coverage. Thus, HCVST could serve as a valuable example for enhancing the uptake of universal HCV screening, even in settings with advanced healthcare systems.

Our study also presented a range of strategic options that policymakers can consider for practical implementation. By offering multiple strategies, including universal, birth-cohort, targeted high-risk group (e.g., persons who inject drugs [PWID] or men who have sex with men [MSM]), we provided a comprehensive framework that facilitates informed decision-making and actionable policy development. While the cost-effectiveness of screening is significantly shaped by critical factors such as HCV prevalence, there remains a substantial lack of empirical data in this area. Consequently, studies investigating the prevalence within PWID and MSM groups are crucial for accurately evaluating the utility of screening in high-risk groups. In our study, anti-HCV seroprevalence among PWID was 0.35, which is 24 to 167 times higher depending on age [7]. Additionally, the prevalence among MSM was 3.04 times higher compared to the general population [8]. These findings highlight the potential of targeted screening to be cost-saving in the long term, as the reduction in medical costs outweighs the screening expenses. However, it is important to note that high-risk groups account for only 16% of the total HCV-infected population [2]. Consequently, while targeted screening is highly effective within these groups, it may fail to identify a substantial number of infections in the general population, making universal screening a more comprehensive approach.

As Jang mentioned, universal screening has been already proved as a cost-effective strategy [1]. Since details in simulation were different between our study and the previous study [9], we fully agree that a direct comparison is not feasible. Although the incremental cost-effectiveness ratio values in our study appear somewhat higher compared to prior analyses, we believe that in the economic evaluation study, the fact that the values remain well within the willingness-to-pay threshold for South Korea is meaningful. Our results were highly robust from the sensitivity analyses in all strategies. This affirms that HCVST is a highly cost-effective alternative, offering an efficient strategy to eliminate HCV. The incremental cost-effectiveness ratio findings underscore the practicality and economic viability of incorporating self-testing into the national health strategy.

In conclusion, we believe that our study contributes meaningfully to the ongoing efforts to combat HCV and provides valuable insights for clinicians and policymakers. We would love to take any further clarifications or discussions.