New modelling presented at the 16th Australasian Viral Hepatitis Conference (12–14 August 2026, Fremantle, Australia) suggests that universal combined hepatitis B, hepatitis C and HIV opt-out testing among people already having blood tests in emergency departments could help identify more infections and link more people to care in high-prevalence urban areas of Australia. This testing strategy was also estimated to offer good value for the healthcare system over a lifetime.
Aim
We assessed the potential health and economic impact of an opt-out approach, where people already having blood tests in an emergency department are routinely tested for all three infections unless they decline.
Context
Australia has made important progress towards eliminating blood-borne viruses, but missed and late diagnoses remain a challenge.
The research highlights that some people who face barriers to accessing routine healthcare may use emergency departments as a point of contact with the health system. This includes culturally and linguistically diverse communities and people who inject drugs, who can be disproportionately affected by late or undiagnosed infection.
Routine opt-out testing in emergency departments could therefore provide another opportunity to identify infections among people who may not be reached through conventional testing pathways.
What we did
We developed a cost-effectiveness model comparing combined blood-borne virus opt-out testing with current testing practice in high-prevalence emergency departments in Australia.
Using Australian data, the model estimated how many additional infections could be diagnosed and how many more people could be connected with care, alongside longer-term health outcomes and healthcare costs.
What we learnt
For every 10,000 emergency department attendees having blood tests, the model estimated that combined opt-out testing would identify 32 additional diagnoses compared with current practice. More than 85% were active chronic hepatitis B or hepatitis C infections.
Combined testing was also estimated to link 17 additional people to care.
Over a lifetime, combined testing was estimated to provide additional health benefits at a cost of A$3,273 per quality-adjusted life year gained compared with current testing; well below the A$50,000 per quality-adjusted life year willingness-to-pay threshold applied in the model.
Hepatitis C opt-out testing alone was estimated to be cost-saving, reflecting the benefits of earlier diagnosis and curative treatment. It remained cost-effective even at 0.1% prevalence.
Linking people diagnosed through testing to appropriate care was an important driver of cost-effectiveness.
Implications
The findings suggest that:
- Emergency departments could provide an additional route to earlier diagnosis, particularly for people who may not be reached through conventional testing pathways.
- Testing is only one part of the pathway. Linking people diagnosed through emergency departments to appropriate care is important both for improving health outcomes and ensuring testing represents good value for the healthcare system.
The model did not capture broader social impacts or the benefits of preventing infections through reduced transmission, so the overall benefits and cost savings may be even greater than estimated.
Taken together, the results indicate that scaling up real-world emergency department opt-out testing could support Australia’s progress towards its blood-borne virus elimination goals.
This work was commissioned and funded by Gilead Sciences and carried out by Aquarius Population Health, informed by Australian expert co-authors.
To learn more about Aquarius Population Health’s work in infectious diseases, health economic modelling and population health, please visit our website or contact info@aquariusph.com.
Citation
Doyle JS, Keen P, Delpech V, et al. Advancing elimination targets for viral hepatitis and human immunodeficiency virus in Australia: estimating the cost-effectiveness of emergency department opt-out testing for blood-borne viruses. [poster] Presented at: 16th Australasian Viral Hepatitis Conference (VH2026); 2026 Aug 12-14; Fremantle, Western Australia, Australia. https://aquariusph.com/app/uploads/2026/09/20260721_APH_Gilead_312-BBV_VH-poster_clean.pdf.