Should all individuals be screened for Hepatitis C?
Posted Sep 18 2012 12:00am
The hepatitis C virus (HCV) is largely curable:
“In clinical trials, antiviral therapy with pegylated interferon and ribavirin (PEG-IFN\u0001R) has resulted in a sustained viral response (SVR) (that is, cure) of HCV infection in 46% of patients infected with genotype 1 (which infects 70% and 90% of chronically infected white and African American persons in the United States, respectively) and as many as 81% of those infected with genotypes 2 or 3.“ (See thesestudies )
Nevertheless, approximately 4.1 million Americans are antibodypositive for hepatitis C virus (HCV), and approximately 75% of them are chronically infected.
Why do so few people get screened for HCV? The CDC limits HCV screening largely to persons with a history of injection-drug use, hemodialysis, or elevated alanine aminotransferase levels. Because screening is targeted and few people get tested, only 25% to 50% of patients with chronic hepatitis C are aware of their infection.
Would more widespread HCV screening be more cost effective?
This is the question a paper by Rein et al. (2012) attempts to answer. The authors examine whether screening all adults born between 1945 and 1965 would be a cost-effective way to improve patient health. HCV prevalence is highest for these cohorts. The authors find that the answer to the question is ‘yes’. Cost per case identified was $2874. Based on historical treatment costs and expected health improvements, the authors found that that the incremental cost effectiviness ratio (ICER) was $15,700 per quality-adjusted life-year (QALY). Adding antiviral therapy in addition to the standard pegylated interferon and ribavirin (PEG+IFN+\u0001R) treatment had a higher ICER of $35,700.
The remainder of the post describes the methods Rein and co-authors use to make these estimates.