David M Brett-Major1,2, Kevin D Frick3, Jennifer A Malia4, Shilpa Hakre5, Jason F Okulicz6, Charmagne G Beckett7, Linda L Jagodinski4, Michael A Forgione6, Philip L Gould8, Stephen A Harrison6, Clinton K Murray6, Francisco J Rentas9, Adam W Armstrong10, Aatif M Hayat11, Laura A Pacha11, Peter Dawson12, Angelia A Eick-Cost13, Hala H Maktabi14, Nelson L Michael4, Steven B Cersovsky11, Sheila A Peel4, Paul T Scott4. 1. Infectious Diseases Directorate, Naval Medical Research Center, Silver Spring, MD. 2. Department of Preventive Medicine and Biometrics, Uniformed Services University, Bethesda, MD. 3. Carey Business School, Johns Hopkins University, Baltimore, MD. 4. Walter Reed Army Institute of Research, US Military HIV Research Program, Silver Spring, MD. 5. US Military HIV Research Program, Henry M. Jackson Foundation, Bethesda, MD. 6. San Antonio Military Medical Center, Fort Sam Houston, TX. 7. Navy Bloodborne Infection Management Center, Bethesda, MD. 8. US Air Force Surgeon's General Office, Falls Church, VA. 9. Armed Services Blood Program Office and the US Army Blood Program, Falls Church, VA. 10. Navy Medical Research Unit 6, Lima, Peru. 11. US Army Public Health Center (Provisional), Aberdeen Proving Ground, MD. 12. The Emmes Corporation, Rockville, MD. 13. Armed Forces Health Surveillance Center, Silver Spring, MD, and Henry M. Jackson Foundation, Bethesda, MD. 14. Office of the Medical Inspector, Veterans Administration, Washington, DC.
Abstract
UNLABELLED: Knowledge of the contemporary epidemiology of hepatitis C viral (HCV) infection among military personnel can inform potential Department of Defense screening policy. HCV infection status at the time of accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period 2007-2010. A cost model was developed from the perspective of the Department of Defense for a military applicant screening program. Return on investment was based on comparison between screening program costs and potential treatment costs avoided. The prevalence of HCV antibody-positive and chronic HCV infection at accession among younger recently deployed military personnel born after 1965 was 0.98/1000 (95% confidence interval 0.45-1.85) and 0.43/1000 (95% confidence interval 0.12-1.11), respectively. Among these, service-related incidence was low; 64% of infections were present at the time of accession. With no screening, the cost to the Department of Defense of treating the estimated 93 cases of chronic HCV cases from a single year's accession cohort was $9.3 million. Screening with the HCV antibody test followed by the nucleic acid test for confirmation yielded a net annual savings and a $3.1 million dollar advantage over not screening. CONCLUSIONS: Applicant screening will reduce chronic HCV infection in the force, result in a small system costs savings, and decrease the threat of transfusion-transmitted HCV infection in the battlefield blood supply and may lead to earlier diagnosis and linkage to care; initiation of an applicant screening program will require ongoing evaluation that considers changes in the treatment cost and practice landscape, screening options, and the epidemiology of HCV in the applicant/accession and overall force populations.
UNLABELLED: Knowledge of the contemporary epidemiology of hepatitis C viral (HCV) infection among military personnel can inform potential Department of Defense screening policy. HCV infection status at the time of accession and following deployment was determined by evaluating reposed serum from 10,000 service members recently deployed to combat operations in Iraq and Afghanistan in the period 2007-2010. A cost model was developed from the perspective of the Department of Defense for a military applicant screening program. Return on investment was based on comparison between screening program costs and potential treatment costs avoided. The prevalence of HCV antibody-positive and chronic HCV infection at accession among younger recently deployed military personnel born after 1965 was 0.98/1000 (95% confidence interval 0.45-1.85) and 0.43/1000 (95% confidence interval 0.12-1.11), respectively. Among these, service-related incidence was low; 64% of infections were present at the time of accession. With no screening, the cost to the Department of Defense of treating the estimated 93 cases of chronic HCV cases from a single year's accession cohort was $9.3 million. Screening with the HCV antibody test followed by the nucleic acid test for confirmation yielded a net annual savings and a $3.1 million dollar advantage over not screening. CONCLUSIONS: Applicant screening will reduce chronic HCV infection in the force, result in a small system costs savings, and decrease the threat of transfusion-transmitted HCV infection in the battlefield blood supply and may lead to earlier diagnosis and linkage to care; initiation of an applicant screening program will require ongoing evaluation that considers changes in the treatment cost and practice landscape, screening options, and the epidemiology of HCV in the applicant/accession and overall force populations.
Authors: Roberto Biselli; Roberto Nisini; Florigio Lista; Alberto Autore; Marco Lastilla; Giuseppe De Lorenzo; Mario Stefano Peragallo; Tommaso Stroffolini; Raffaele D'Amelio Journal: Biomedicines Date: 2022-08-22
Authors: Paul T Scott; Robert L Cohen; David M Brett-Major; Shilpa Hakre; Jennifer A Malia; Jason F Okulicz; Charmagne G Beckett; Jason M Blaylock; Michael A Forgione; Stephen A Harrison; Clinton K Murray; Francisco J Rentas; Roland L Fahie; Adam W Armstrong; Aatif M Hayat; Laura A Pacha; Peter Dawson; Beth Blackwell; Angelia A Eick-Cost; Hala H Maktabi; Nelson L Michael; Linda L Jagodzinski; Steven B Cersovsky; Sheila A Peel Journal: Mil Med Date: 2020-09-18 Impact factor: 1.437
Authors: Christina Greenaway; Iuliia Makarenko; Claire Nour Abou Chakra; Balqis Alabdulkarim; Robin Christensen; Adam Palayew; Anh Tran; Lukas Staub; Manish Pareek; Joerg J Meerpohl; Teymur Noori; Irene Veldhuijzen; Kevin Pottie; Francesco Castelli; Rachael L Morton Journal: Int J Environ Res Public Health Date: 2018-09-14 Impact factor: 3.390