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Screening Canadians for hepatitis C infection could be cost-effective and save lives

Screening all Canadians of a certain age for chronic hepatitis C could be cost-effective and save lives, indicates a study published in CMAJ (Canadian Medical Association Journal).

Chronic hepatitis C (HCV) infection is difficult to detect during routine medical visits because there are usually no symptoms. It is often diagnosed in the advanced stages of the disease, making treatment difficult and often resulting in death. Complications may be reduced with each detection and timely treatment.

Updated US guidelines recommend that all people born between 1945 and 1965 should be screened for hepatitis C.

To determine whether screening for hepatitis C would be cost-effective in Canada, researchers developed a modelling study with four screening strategies for adults 25-64 or 45-64 years of age:

  1. No screening (current practice).
  2. Screen and treat with pegylated interferon-ribavirin: Patients are offered a one-time screen via blood test for the hepatitis C antibody from their primary care physician. Patients with a confirmed positive result would be referred to a specialist and receive pegylated interferon-ribavirin treatment according to current guidelines.
  3. and 4. Screen and treat for specific virus genotype: In addition to the strategy above, patients would be offered different direct-acting antiviral therapies according to the HCV genotype.

The researchers found that with a selective one-time HCV screening program, for every 10 000 people screened, about 63 cases of HCV would be detected, and 59% (37 people) would be eligible for treatment, preventing 9 deaths.

“Our analyses suggest that in Canada, a 1-time program to screen for and treat HCV infection, aimed at birth cohort populations (25-64 or 45-64 years of age), is likely to be cost-effective,” writes Dr. William Wong, Toronto Health Economics and Technology Assessment Collaborative, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, with coauthors. “The screening programs that we evaluated would identify people with chronic HCV infection who are asymptomatic, which would in turn allow medical treatment to be offered, if needed, according to published guidelines, ideally before development of advanced liver disease.”

Early identification of people with this chronic liver disease could help people manage their lifestyles to prevent further liver damage, link them with treatment, prevent long, costly hospital stays and save lives.

Source

Cost-effectiveness of screening for hepatitis C in Canada, William W.L. Wong PhD, Hong-Anh Tu PhD, Jordan J. Feld MD MPH, Tom Wong MD MPH, Murray Krahn MD MSc, CMAJ, DOI:10.1503 /cmaj.140711, published 12 January 2015.