A statewide effort to eliminate hepatitis C in Washington led to a shift in testing and treatment trends, according to an analysis of more than 21 million people published in  JAMA Network Open.

Hepatitis C virus (HCV) testing rose significantly after the initiative launched in 2019, initially driving up diagnosed cases, but prevalence gradually declined and overall care costs fell, suggesting that expanded access could pay off over time.

In July 2019, as part of Governor Jay Inslee’s directive, the Washington State Department of Health released an HCV elimination strategy, called Hep C Free Washington: Plan to Eliminate Hepatitis C in Washington State by 2030. This involved a new purchasing plan for antiviral drugs along with clinical and community strategies to help coordinate treatment, surveillance and reporting.

Ashley Tabah, PhD, at the University of Washington, Seattle, and colleagues studied trends in HCV prevalence, screening and treatment before and after this mandate was passed. The team used the Washington State All-Payer Claims Database, which collects data for people who receive care in the state. The team accessed data for more than 21 million people. The average age was 44 years, and 53% being women.

Before and just after the initiative was launched, HCV testing numbers remained stable. But in the third quarter of 2020, screening rose by 10.5 additional tests per month for every 1,000 enrollees. As testing rose, so too did the detection of chronic hepatitis C, which initially increased through 2021 and then dropped by 0.4 per 1,000 enrollees when comparing 2019 Q2 to 2022 Q3. From 2017 through early 2021, the percentage of newly diagnosed people receiving antiviral therapy increased by 8%, from 17% to 35%. Compared to 2019 Q2, the cost for every existing case dropped by $520 per month by 2021 Q1.

“The findings from this longitudinal case series analysis of claims data suggest that Washington State’s elimination initiative, combined with revised national screening guidelines and improved treatment options, has contributed to significant expansion of HCV screening and changes over time in the proportion of people identified and treated for HCV,” wrote the researchers. “Decreasing costs per person suggest that screening and curative treatment goals are imperative.”

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