[Reporter’s View] Decide whether to offer free HCV testing

whether HCV screening should be included in the national health examination program

Eight years have passed since discussions began on adding hepatitis C (HCV) screening as a free item in Korea’s national health examination program.

 

Despite various supporting evidence that was produced during the period, including the feasibility study that started in 2016, and an analysis that showed that it was cost-effective to include HCV as a national health examination item, as well as the results of the pilot project, the government's intentions are still unclear.

 

Recently, more feasibility analyses and follow-up management measures have also been released on the matter.

 

One of the major reasons why the government was reluctant to introduce HCV screening to the national health examination was its prevalence rate.

 

The first principle among the five conditions that must be satisfied for items to be added to the system is for the disease to be a ‘serious health condition,’ which is evaluated by whether the prevalence rate is 5% or higher.

 

However, the prevalence rate of HCV is around 1%, therefore being unable to satisfy the condition.

 

Its highest prevalence rate is in the 1.7% range for those aged in their 70s.

 

Although the global prevalence rate of HCV remains below 1%, the World Health Organization has a different view on the gravity of the situation.

 

The WHO had set the goal of eradicating HCV by 2030 and urged governments to actively implement policies on their part to achieve this goal.

 

This goal was set as HCV can be easily cured with early diagnosis with the development of treatments, but also carries an increased risk of developing severe diseases such as liver cirrhosis or liver cancer when left untreated.

 

The direct-acting antiviral (DAA) medications that were introduced to the field led to the era of curing HCV.

 

Also, a retreatment option exists for the 1% of patients who fail treatment.

 

This is why the WHO defined HCV as the next disease that can be eradicated after the smallpox virus.

 

Even so, Korea is still stuck on the prevalence rate.

 

An official from the Ministry of Health and Welfare who had attended the ‘32nd Conference of the Asian Pacific Association for the Study of Liver 2023 (APASL 2023),’ mentioned the prevalence rate of HCV in Korea, saying “Korea has a national health examination system in place for all citizens.

 

Therefore, adding HCV screening as an item to the system can have a serious impact, and items should be careful and conservatively added in strict compliance with the set principles.” The remark seems to have been made to imply the authorities' stance on whether HCV screening, which has a low prevalence rate, should be included in the health examination system that is for the entire Korean population.

 

If the prevalence rate was going to be a barrier in the first place, the government wasted more than KRW 1.3 billion in research funds on a concluded issue.

 

No matter how cost-effective the introduction of hepatitis C screening is, all discussions become meaningless if the government raises prevalence as an absolute requirement.

 

But diseases with a prevalence rate of less than 5% are already included for screening in the national health examination system.

 

Therefore, the prevalence rate cannot be an absolute criterion for introducing items in the national health examination system.

 

The government will soon be reviewing the research results that were newly presented this year.

 

If it mentions the prevalence rate again this time, it would be safe to interpret their stance as saying, “Actually, the prevalence is just an excuse and the government has no intention of investing money in HCV." After 8 years of false hope, now is the time to draw a conclusion already.