Point-of-care RNA testing for hepatitis C virus could increase hospital laboratory costs by up to 260 percent if implemented broadly, according to an analysis of more than 325,000 test results from a Seattle medical system published in the Journal of Clinical Microbiology.
Researchers from the University of Washington examined 8 years of hepatitis C virus (HCV) testing data across three hospitals to evaluate implementation strategies for newly FDA-authorized rapid RNA tests. While these tests can deliver results during a single emergency department visit – potentially enabling immediate treatment initiation – the cost implications present significant challenges for healthcare systems.
Converting all HCV screening to point-of-care RNA testing would add approximately $2.9 million annually in laboratory costs for the three-hospital system, or $6,439 per infection detected. Even restricting the technology to just the public county hospital emergency department would increase costs by $246,143 yearly, representing a 22 percent rise in testing expenses.
The study found that emergency department testing increased 682 percent from 2017 to 2024, with one-third of all HCV diagnoses now originating from the county hospital emergency department serving safety-net populations. This setting showed a 10.3 percent antibody positivity rate – substantially higher than the 2.7 percent rate in outpatient clinics.
Traditional two-step testing – using antibody screening followed by confirmatory RNA testing – resulted in median turnaround times of 84 hours, far too long for emergency department visits. Switching to newer laboratory platforms reduced this to 45 hours, but still insufficient for same-visit treatment decisions.
The analysis identified HCV antigen testing as a potentially cost-effective alternative. This approach, widely used internationally but not yet FDA-approved in the United States, would detect an estimated 98 percent of infections while adding only $11,494 in annual costs when implemented in the county hospital emergency department – less than one-twentieth the expense of point-of-care RNA testing.
Current Medicare reimbursement rates significantly underestimate actual laboratory costs for point-of-care RNA testing, which includes higher reagent prices and increased staffing requirements compared to traditional methods.
The findings highlight the need for targeted deployment strategies and dedicated funding mechanisms to support HCV elimination efforts without depleting laboratory resources needed for other testing services.
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