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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 these studies )

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.

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