Poland continues to face challenges in meeting viral hepatitis and HIV elimination goals. Diagnosis rates for hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV remain below elimination targets, while delayed diagnosis and gaps in linkage to care contribute to poorer health outcomes. Since 2022, forced migration from Ukraine has increased the number of people living with blood-borne viruses (BBVs) in Poland, adding pressure to healthcare systems.
Through opt-out testing (OOT), emergency departments (EDs) may offer an opportunity to improve earlier diagnosis and linkage to care, particularly for people who are less routinely engaged with traditional healthcare services.
What we did
In a recent study, we assessed the potential clinical and economic impact of introducing ED BBV OOT in Poland, compared with standard of care, in which systematic ED testing is not implemented.
Using a decision tree model, we estimated short-term outcomes, and used a lifetime Markov model to estimate long-term clinical and economic outcomes from the perspective of the Polish National Health Insurance provider.
Key findings
The model estimated that, for every 10,000 people tested, ED BBV opt-out testing could result in:
- 128 additional blood-borne virus diagnoses
- 95 individuals successfully linked or re-linked to care
Across infections:
- HIV: 28 new diagnoses and 19 linked to care
- HBV: 72 new diagnoses and 66 linked to care
- HCV: 27 new diagnoses and 10 linked to care
Combined ED BBV opt-out testing was found to be cost-effective over a lifetime horizon, with an estimated weighted average cost per QALY gained of €14,563, below the Polish willingness-to-pay threshold of €33,079. Scenario analyses showed that the intervention remained cost-effective even when HIV and HCV prevalence estimates were reduced to 0.1%. Successful linkage to care following diagnosis was also identified as a major driver of long-term cost-effectiveness.
Implications
These results suggest that integrated BBV opt-out testing in EDs could support progress towards viral hepatitis and HIV elimination targets in Poland by improving earlier diagnosis and linkage to care.
Overall, the study highlights the potential value of systematic ED-based testing pathways in high-prevalence settings and reinforces the importance of strong linkage to care systems in achieving long-term public health and economic benefits.
The findings of this research were presented at the European Association for the Study of the Liver (EASL) in Barcelona, Spain, in May 2026. Poster link.
Article by Ellie Moran and Hairuo He – June 2026