OBJECTIVES: To achieve the goal towards hepatitis C virus (HCV) elimination proposed by the World Health Organization (WHO), interventions to improve testing, facilitate linkage and treatment are necessary. Our analysis estimated the impact on healthcare outcomes of chronic HCV diagnosis based on a single blood sample (one-step diagnosis) in Andalucía, Spain (8.39 million people), from a National Health System perspective.

METHODS: A decision tree model was developed to estimate the impact on detection, referral to specialists, loss of follow-up and access to treatment comparing one-step diagnosis versus standard diagnosis, in which HCV viremia is not investigated in the first visit. A total of 269,526 individuals were estimated to be screened for HCV (67% outpatient and 33% inpatient care). In both scenarios, diagnosis was based on HCV antibody testing, HCV-RNA (viral load) and genotyping. Patient follow-up included: initial visit, diagnosis testing, referral or not to specialists and, where appropriate, treatment. All data for the model were obtained from literature or, if not available, from an Expert Panel.

RESULTS: In the analysis, a total of 2,830 individuals of the tested population would be detected as positive for HCV antibody, of whom 1,876 would be HCV-RNA+ve. From this population, using one-step diagnosis, 1,389 chronic HCV patients were referred to specialised care (1,320 treated) and 1,063 patients (1,009 treated) with standard diagnosis. No HCV-RNA-ve patient were referred to specialist using one-step diagnosis versus 540 with standard diagnosis. Compared to one-step diagnosis, using standard diagnosis 63% more patients were not referred to specialists and 30% more patients were considered a lost to follow-up.

CONCLUSIONS: One-step diagnosis simplifies the HCV diagnosis procedure, enhancing linkage to care as more patients with chronic infection are identified and treated, making better use of healthcare outcomes, and contributing to achieve the WHO HCV elimination target.