Translating Hepatitis D Virus Screening Cost-Effectiveness into Practice: The Case for Reflex Testing in the United States

We read with great interest the recent study by Toy et al. demonstrating the cost-effectiveness of one-time hepatitis delta virus (HDV) testing among HBsAg-positive adults in the United States.i As the authors highlight, HDV is the most aggressive form of viral hepatitis, yet only ~13% of adults with chronic hepatitis B virus (HBV) are ever tested in the US.ii We commend the authors for advocating for universal HDV screening in HBsAg-positive adults in the US, as advised by the European Association for the Study of the Liver.iii Recommending one-time HDV screening on account of its cost-effectiveness is a step in the right direction, but efforts should be made to consider how we may optimize implementation to ensure the testing is done.CDC guidance recommends a one-time HBV triple panel screen for all adults, which is an ideal opportunity to also implement reflex HDV testing.iv Reflex testing may prove to be even more impactful and cost-effective, reducing potential missed diagnoses and detecting patients earlier in their disease course.