Efficiency of decentralized screening for hepatitis C in different healthcare settings: retrospective study over 6 years in southeastern Spain

Background: One of the objectives proposed by the World Health Organization (WHO) for the period 2022-2030 is to employ new strategies to combat hepatitis. Since universal screening has not been implemented in Spain, opportunistic screenings are being conducted in different healthcare settings. This work analyses the efficiency of this process on the south-eastern region of Spain (Alicante). Methods: The efficiency of screening to detect hepatitis C virus (HCV) conducted in emergency, gynecology, surgery, primary care, nephrology, occupational risk accidents, and hematology (opportunist screenings) was compared against the screening conducted in prisons and in vulnerable populations (decentralized screening) using dry blood spot (DBS) testing between 2017 and 2023. The screening cost was calculated applying the Fee Law of the Valencian Community. Results: A total of 66,532 samples were analyzed, out of which viral genome was detected in 315 (0.47%). The prevalence of HCV-positive antibodies in patients from healthcare settings was 0.44%, of which 0.14% had detectable viral RNA (vRNA). In contrast, decentralised screening detected 27.28% positive HCV antibodies and 10.28% viral genomes. In this context, prisons showed a prevalence of positive antibodies and vRNA of 7.39% and 3.30%, respectively. In DBS samples, the prevalence of positive antibodies was 19.89%, with 6.98% showing vRNA. When analyzing the costs of screening processes, the costs of screening patients from gynecology are 89,966 € per patient positive for vRNA, decreasing to 6,744 € in primary care, to 2,983 € in the emergency department, to 518 € in prisons and to 405 € in DBS. Conclusions: Focusing on opportunistic screening, the most cost-effective approach is carried out in the emergency department. Regarding decentralized screening, this study has demonstrated that it is highly effective in our setting, as it targets disadvantaged populations with a high prevalence of infection. Therefore, this screening should be promoted and evaluated to establish its efficacy elsewhere and to advance the detection of patients infected with HCV.