{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:19:09Z","timestamp":1788175149129,"version":"build-2803163510"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The standard of care (SOC) laboratory-based hepatitis C virus (HCV) diagnostic algorithm is associated with high rates of undiagnosed cases, patients lost to follow-up, and low rates of treatment initiation, particularly among high-risk populations. Improving diagnostic efficiency is critical for HCV elimination.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the cost-effectiveness of a point-of-care (POC) HCV RNA-first diagnostic strategy compared with SOC across care settings in the US serving people at high-risk of HCV infection.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This economic evaluation used a hybrid decision tree and HCV transmission model using real-world claims data and published literature. The model projected clinical and economic outcomes over 1-year and lifetime horizons. Hypothetical cohorts of individuals eligible for HCV testing were modeled in each of 4 care settings\u2014community health centers, emergency departments, harm reduction clinics, and mobile outreach or street medicine programs in the US\u2014and assumed to be primarily people who inject drugs.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n POC HCV RNA-first testing vs SOC laboratory-based HCV antibody and reflex confirmatory RNA testing.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were rates of HCV diagnosis, linkage to care, treatment initiation, sustained virologic response at week 12 after treatment, forward transmission, long-term complications, costs, and incremental cost-effectiveness ratios. One-way and probabilistic sensitivity analyses assessed the impact of uncertainty on results.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among modeled cohorts, POC HCV RNA-first testing identified 93.4% of cases vs up to 68.7% with SOC. POC HCV RNA-first testing increased linkage to care (by 37.6%-73.4%), treatment initiation (by 12.1%-48.9%), and sustained virologic response at week 12 after treatment (by 3.6%-26.4%) across care settings. Forward transmission was reduced by 16.3% to 53.3%. Initial costs were higher in some settings, but lifetime costs were lower, with savings of $3387 per person tested. The POC HCV RNA-first strategy was dominant (lower costs and improved outcomes) over SOC across all settings analyzed.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this economic analysis of HCV testing strategies, a POC HCV RNA-first approach was found to be cost-effective and clinically optimal for high-risk populations, and may represent a critical component of HCV elimination efforts in the US.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.2658","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T15:30:29Z","timestamp":1774020629000},"page":"e262658","source":"Crossref","is-referenced-by-count":2,"title":["Cost-Effectiveness of Point-of-Care Hepatitis C Virus RNA Testing in the US"],"prefix":"10.1001","volume":"9","author":[{"given":"Neda","family":"Al Rawashdh","sequence":"first","affiliation":[{"name":"Real-world Evidence Solutions, IQVIA, Falls Church, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl P.","family":"Ferrufino","sequence":"additional","affiliation":[{"name":"Real-world Evidence Solutions, IQVIA, Falls Church, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mindy M.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Value & Access, Cepheid, Sunnyvale, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivang P.","family":"Doshi","sequence":"additional","affiliation":[{"name":"Value & Access, Cepheid, Sunnyvale, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily B.","family":"Kahn","sequence":"additional","affiliation":[{"name":"Real-world Evidence Solutions, IQVIA, Falls Church, 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