Will the government include hepatitis C in the national health screening program this year?
The Korean Association for the Study of the Liver has stressed the need to introduce a national checkup to eradicate hepatitis C in Korea for over a decade.
The association has maintained that Korea established an excellent health examination system for the transition period of the life cycle, detecting hepatitis C at an effective cost when a national examination is introduced, and ultimately eradicating hepatitis C by 2030 as targeted by WHO.
To this end, the association held several expert forums and parliamentary debates. It also proved the cost-effectiveness demanded by the government through two pilot projects. However, due to opposition from some in the medical community, the introduction of national hepatitis C screening has been repeatedly thwarted.
Against this backdrop, a report titled “The feasibility of hepatitis C screening in national health examination items” was published on the PRISM (Policy Research Information Service & Management) website, drawing attention.
The association wrote the report at the request of the Korea Disease Control and Prevention Agency (KDCA).
The study reaffirmed the cost-effectiveness of the national screening of hepatitis C as proved by previous pilot projects, and suggested a follow-up management plan after its introduction into the national health examination program.
Those pilot projects showed that tests for people aged 40 to 65 who are at increased risk of hepatitis C infection are cost-effective, and conducting hepatitis C screening, whether it's for the entire population or only for the high-risk group, is more cost-effective than not.
In the latest study, researchers analyzed from the viewpoint of the health and medical system the effects of hepatitis C antibody tests in 40-64-year-olds as part of a national screening program compared to the current situation where there are no such tests. As a result of analyzing the perspective of the health care system, including direct medical expenses, ICER (Incremental cost-effectiveness ratio) was estimated at 13,989,037 won ($1,136)/QALY (quality-adjusted life year).
In addition, they analyzed from the social viewpoint by including direct medical costs, direct non-medical costs, and productivity loss caused by early deaths from liver diseases. As a result, the ICER was 10,899,747 won/QALY, lower than the cost-effectiveness domestic threshold of 2.5 million won/QALY. Accordingly, it reaffirmed cost-effectiveness from both health-medical and social viewpoints.
After the diagnosis of hepatitis C, a system linked to treatment needed
The association added that the introduction of HCV reflex testing, an initial test that connects HCV (chronic hepatitis C virus) antibody test to RNA tests, reduces the number of patients’ hospital visits, saving money and time, reducing the examination rate of HCV RNA tests and connection time, and ultimately raising the treatment rate.
It cited the example of Taiwan, which introduced the RNA system as a model to enhance the management and treatment linkage of hepatitis C, improving the diagnosis rate of hepatitis C from 23.3 percent to 100 percent, and raising the treatment rate from 27.8 percent to 73.9 percent.
RNA is a model that introduces HCV reflex testing for hepatitis C diagnosis, applies a real-time automated appointment system to increase accessibility to care, and lets trained nurses consuls over the phone for patients who have not received medical treatment.
The study also said it is necessary to lower the drug price for direct-acting antiviral agents (DAA), which are oral treatments.
According to the 2020 national health and nutrition survey, the positive rate of hepatitis C antibodies in adults aged 19 or older in Korea is 0.7 percent. However, it shows differences by age group, rising from those in their 40s to the highest among those in their 70s, at 1.7 percent.
“Hepatitis C progresses to serious liver diseases, such as cirrhosis and hepatocellular carcinoma, if patients fail in initial treatment,” the association said. “It is an important health issue, considering that the country's financial burden due to severe diseases increases as the diseases progress.”
Medical expenses due to hepatitis and related diseases accounted for 11.5 percent of total medical expenses in 2020.
Such a heavy financial burden explains why WHO also requests national governments to participate in policymaking to eliminate hepatitis worldwide by 2030 actively.
In a revised guideline in 2017, WHO recommended screening for the high-risk group of hepatitis C, or the prevalence rate of 2 percent or 5 percent for the entire population, depending on the situations and subjects with a relatively high prevalence and infection risk.
Hepatitis C can be completely cured by more than 98 percent if diagnosed early and treated with short-term (eight-12 weeks) DAA treatment. However, hepatitis C requires patient screening because there are many asymptomatic infections. Accordingly, it is time for Korea to make a national decision to end hepatitis C quickly, the association said.