LAUSR

Introduction The prevalence of blood borne viruses is higher in emergency department (ED) attendees compared to the general population, due to higher attendance of marginalised populations. Studies have found prevalence up to 2% and 3% for hepatitis B (HBV) and hepatitis C (HCV) in EDs in England. HIV testing in EDs in the UK is recommended in high prevalence areas (≥0.2%), but there is no defined threshold for hepatitis testing. Methods A Markov model was developed to analyse the impact of opt-out hepatitis C (HCV) and hepatitis B (HBV) testing in EDs in the UK. The model used data from studies of ED testing in the UK to parameterise test costs and intervention effects (contact rates and linkage to care). For HCV we used an antibody test cost of £3.64 and RNA test cost of £68.38, and assumed a direct acting antiviral (DAA) treatment cost of £10,000. For HBV, we used a HBsAg test cost of £3.51. We considered what prevalence of HCV (RNA-positive) and HBV (HBsAg) would be required to make ED testing cost-effective at a threshold of £20,000 willingness to pay (WTP) per quality adjusted life year (QALY) gained. Results The prevalence required for ED testing to be cost-effective was 0.3% HCV RNA prevalence, and 0.2% HBsAg prevalence, under the base case parameters (figure 1). The prevalence thresholds were sensitive to the cost of the diagnostic tests and the linkage to care achieved (proportion of patients contacted with diagnosis, attend referral and receive treatment), and DAA treatment costs for HCV.Abstract PTU-039 Figure 1 Conclusions Early evidence suggests that ED testing and ED based linkage to care for HCV and HBV is likely to be cost-effective in many geographical areas across the UK. Additional studies are required to evaluate ED testing across regions, and this can inform public health guidelines in the UK.