Broader Screening Needed For Hepatitis C

Broader screening to identify people infected with hepatitis C virus (HCV) would likely be cost effective, and significantly reduce HCV-related mortality and morbidity.

A coordinated effort is required that emphasizes not only increased testing of high-risk individuals, and the 50% to 75% of infected persons who remain unaware of their status, but also linking those infected with the treatment they need.

A study carried out at the University of Washington (Seattle, WA, USA) estimated the cost-effectiveness and population-level impact of adding one-time HCV screening of US population aged 20-69 years. The primary analysis compared risk factor-based screening, the current standard of care, to risk factor-based screening plus one-time screening of the general adult US population within that age group.

The investigators used statistical modeling techniques to analyze the benefit of broadening screening guidelines. The model added a one-time screening for all adults between the ages of 20 and 69 and factored in the costs of managing late-stage liver fibrosis versus the costs of attempting to cure patients of HCV. They found that screening all adults was cost effective across a wide range of assumptions related to the costs and effects of screening and treatment. At the same time, the proportion of deaths averted by screening is likely to be relatively small, unless testing efforts are accompanied by substantial increases in successful referral of infected persons for treatment.

Compared to current guidelines, incremental cost per quality-adjusted life year gained was USD 7,900 for general population screening and USD 4,200 for screening by birth year, which dominated general population screening if cost, clinician uptake, and median age of diagnoses were assumed equivalent. Phillip O. Coffin, MD, who led the team, said, "Hepatitis C is a lot like HIV. The US took a long time to come to the conclusion that we needed to really emphasize testing and efforts to link people to care. Hepatitis C is the same. We need a large scale, coordinated effort to identify people with this infection and make sure they get the care they need.” The study was published on March 12, 2012, in the journal Clinical Infectious Diseases.

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University of Washington