Table 1.

Costs of HCV Testing Strategies by Patient Group and Anti-HCV Prevalence

	Retrospective	Projected
	Elevated transaminases (HCV Ab + 12.0%)	Birth cohort (HCV Ab + 3.25%)	Elevated transaminases (HCV Ab + 12.0%)	Elevated transaminases (HCV Ab + 8.4%)3	Elevated transaminases Trans (5.5%)*
	n = 4873	n = 8698	n = 6100	n = 6100	n = 6100
HCV Ab with reflex RNA
Total cost†	$100,146.68	$151,851.64	$125,352.56	$117,594.09	$111,344.22
Cost/pt tested	$20.55	$17.46	$20.55	$19.28	$18.25
Cost/diagnosis‡	$214.45	$709.61**	$214.09***	$286.87***	$414.84***
Direct RNA testing
Total cost	$172,163.09	$307,300.34	$215,513.00	$215,513.00	$215,513.00
Cost/pt tested	$35.33	$35.33	$35.33	$35.33	$35.33
Cost/diagnosis‡	$368.66	$1436.03	$368.02	$525.74	$802.95

HCV Ab testing was $15.85 (CPT 86803) and HCV RNA testing was $31.22 (CPT 87520).⁵ Specimen collection tubes cost $0.46 and $4.11 for the HCV Ab and RNA tests respectively (https://www.fishersci.com). Phlebotomy costs were assumed equal. Total cost for HCV Ab negative patients was $16.31, $51.64 for HCV Ab positive patients (Ab + RNA), and $35.33 for patients with direct RNA testing

^*This prevalence that would be expected in the remaining, untested individuals if we assume an overall anti-HCV prevalence of 8.4% for all patients with elevated aminotransferases and account for the 585 already testing positive

^†Cost = 16.31n +35.33(anti-HCV prevalence × n)

^‡= 76 pts with missing RNA. Assuming an additional 0.8 × 76 = 60 HCV RNA diagnoses. Total HCV diagnosis now 467

^**Assuming 75.7% of HCV Ab–positive birth cohort patients were HCV RNA positive (8698 × .0325 × 0.757)

^***Assuming 80.0% of HCV Ab–positive patients with HCV RNA testing were HCV RNA positive (6100 × prevalence × 0.8)