To the  Editor—We read with great interest about the recent study by Toy et al [1] demonstrating the cost-effectiveness of one-time hepatitis D virus (HDV) testing among hepatitis B surface antigen (HBsAg)–positive adults in the United States. As the authors highlight, HDV is the most aggressive form of viral hepatitis, yet only about 13% of adults with chronic hepatitis B virus (HBV) are ever tested in the United States [2]. We commend the authors for advocating for universal HDV screening in HBsAg-positive adults in the United States, as advised by the European Association for the Study of the Liver [3]. 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. The Centers for Disease Control and Prevention (CDC) recommends a one-time HBV triple-panel screen for all adults, which is an ideal opportunity to also implement reflex HDV testing [4]. Reflex testing may prove to be even more effectual and cost-effective, reducing potential missed diagnoses and detecting patients earlier in their disease course.