Broader Screening for Hepatitis C Would Be Cost Effective, Study Suggests
Linking those infected with care is key to reducing related mortality and morbidity
March 14, 2012 - Broader screening to identify people infected with hepatitis C virus (HCV) would
likely be cost effective, according to a new report published in Clinical Infectious Diseases and
available online . Significantly
reducing HCV-related mortality and morbidity, however, will require a coordinated effort that emphasizes not only increased testing but also linking those infected with the treatment they need.
The HCV epidemic peaked many years ago, but roughly 4 million U.S. residents still suffer the consequences of chronic
hepatitis C. A growing proportion of those infected now has advanced disease, including cirrhosis of the liver and
liver cancer. Deaths from chronic infection have doubled over the last decade and are expected to more than double
again by 2030.
The current "risk factor-based approach to screening has failed to identify at least half of those infected, leading
to a situation in which a quarter of those newly diagnosed already suffer from cirrhosis of the liver," said
Dr. Phillip O. Coffin, who led a team of researchers, including Drs. John D. Scott, Matthew R. Golden, and
Sean D. Sullivan, at the University of Washington in Seattle who estimated the cost-effectiveness and
impact of HCV screening.
Adding a one-time screening for all adults between the ages of 20 and 69 and factoring in the costs of managing
late-stage liver fibrosis versus the costs of attempting to cure patients of hepatitis C, Dr. Coffin's team used
statistical modeling techniques to analyze the benefit of broadening screening guidelines. 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.
"The stealth epidemic of hepatitis C has finally matured, leaving a narrow window of opportunity to find those with
advancing disease, connect them with care, and prevent the tragic and costly consequences of liver cancer and
end-stage liver disease," Dr. Coffin said. Doctors are hampered by current overly narrow screening
guidelines, and managing chronic HCV infection becomes increasingly expensive as it progresses.
"We need to screen the population, but that won't be enough to make a big difference," Dr. Coffin said. "Hepatitis C
is a lot like HIV. The U.S. 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."
Clinical Infectious Diseases is a leading journal in the field of infectious disease with a broad international
readership. The journal publishes articles on a variety of subjects of interest to practitioners and researchers.
Topics range from clinical descriptions of infections, public health, microbiology, and immunology to the
prevention of infection, the evaluation of current and novel treatments, and the promotion of optimal
practices for diagnosis and treatment. The journal publishes original research, editorial
commentaries, review articles, and practice guidelines and is among the most highly
cited journals in the field of infectious diseases. Clinical Infectious Diseases
is an official publication of the Infectious Diseases Society of America
(IDSA). Based in Arlington, Va., IDSA is a professional society
representing nearly 10,000 physicians and scientists who
specialize in infectious diseases. For more information,
visit www.idsociety.org .
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Infectious Diseases Society of America (IDSA)