Summary
A University of Washington study analyzed HCV testing costs across its system from 2017 to 2024, focusing on the public county hospital ED where one-third of diagnoses occur. The study compared the costs of implementing point-of-care HCV RNA testing versus the traditional two-step algorithm. While point-of-care testing offers faster results, it significantly increases laboratory costs, prompting the need for policy changes to support reimbursement for this approach.
Meredith Salisbury
March 2026—A University of Washington study analyzed hepatitis C virus testing across the UW system from 2017 to 2024 to inform the use of HCV RNA screening and to estimate laboratory costs associated with five testing approaches (Helm EW, et al. J Clin Microbiol. 2026;64[1]:e0125925).
The current recommended HCV screening algorithm begins with antibody testing that is followed by reflex HCV RNA testing if the antibody result is positive, but confirmatory testing generally cannot be completed during a single emergency department visit.
A multicenter randomized clinical trial consisting of 147,498 ED patient visits found that while many patients had been newly diagnosed with HCV infection, clinician referral from the ED resulted in only 20 percent who were successfully linked to care and 16 percent of patients beginning treatment (Haukoos J, et al. JAMA. 2025;334[6]:497–507).
The Food and Drug Administration in 2024 granted marketing authorization to Cepheid for its Xpert HCV test and GeneXpert Xpress system, the first HCV RNA test for use at the point of care, including in EDs.
“Our clinicians are very excited about this new test from Cepheid,” says Alex L. Greninger, MD, PhD, MS, MPhil, coauthor of the UW article and head of the Division of Infectious Disease Diagnostics, Department of Laboratory Medicine and Pathology, and the Larry Corey endowed professor of laboratory medicine and pathology. The test, which provides results in about an hour, has “a lot going for it,” he says, “but it doesn’t necessarily scale super well.”
There are three UW hospitals: an academic medical center, a public county hospital, and a community hospital, each with its own ED. HCV antibody and viral load tests are performed in the off-site UW virology laboratory. HCV antibody testing volumes increased from 26,188 tests in 2017 to 45,010 tests in 2024.
The analyses performed in the study were largely focused on the county hospital ED, where viral load testing rose 6.6-fold between 2017 and 2024 and the positivity rate for detectable viral loads was high: 31 percent in 2024.
“The part that stuck out to me was that one-third of our diagnoses now come from the ED at our public county hospital,” Dr. Greninger says. The HCV screening program the UW had set up was outpatient oriented. “We didn’t have to have the result while the patient was in the office, but it doesn’t work in the ED population when you may never see the patient again.”
The median collection-to-RNA result turnaround time was 84 hours for reactive screening tests from January 2017 to October 2024. In November 2024 viral load testing was switched to the Hologic platform, enabling three runs per week and reducing the median TAT to 45 hours.
The authors examined various scenarios for using point-of-care HCV RNA testing instead of initial antibody testing, using 2024 data: 1) for all HCV testing, 2) for inpatient and ED testing only, 3) for ED testing only, 4) for public county hospital ED testing only, and 5) not using it and remaining with the traditional two-step algorithm for all HCV testing. To estimate costs, they used the 2025 Medicare reimbursement rates for HCV antibody testing ($14.27 per test) and viral load quantification ($42.84).
The findings were as follows:
- If all testing remained as a two-step algorithm, the total laboratory cost was $704,848.
- Implementing single-step point-of-care HCV RNA testing for all screening would add $1,172,744 to the laboratory cost.
- Limiting single-step POC HCV RNA testing to inpatient and ED settings would raise laboratory cost by $211,703.
- If single-step POC HCV RNA were limited to the EDs at the three hospitals, laboratory cost would increase by $135,450, and if limited to the public county hospital ED, by $94,051.
- Costs per HCV infection detected would be $4,210 for universal single-step RNA testing, $2,055 for inpatient and ED testing, $1,884 for all ED testing, and $1,791 for the county hospital ED.