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Clinical Guidelines: U.S. Preventive Services Task Force* Screening for Hepatitis C Virus Infection in Adults: Recommendation Statement Ann Intern Med 2004; 140: 462-464 [Abstract] [Full text] [PDF]

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Cost-effectiveness of screening for Hepatitis C

Sandra C Fuchs, Ajacio Brandão, MD, Associate Professor, and Guilherme Mariante, MD   (9 November 2004)

Cost-effectiveness of screening for Hepatitis C 9 November 2004
Sandra C Fuchs, MD, PhD Associate Professor, Social Medicine Department, Universidade Federal do Rio Grande do Sul, Ajacio Brandão, MD, Associate Professor, and Guilherme Mariante, MD Send rapid response to journal: Re: Cost-effectiveness of screening for Hepatitis C scfuchs{at}terra.com.br Sandra C Fuchs, et al.	Alter MJ and collaborators(1)commented the recently published guidelines for HCV testing from Centers for Disease Control and Prevention (CDC)(2) and the U.S. Preventive Services Task Force (USPSTF)(3). They highlighted the lack of consensus of the USPSTF (not in favor or against) and CDC (in favor) of testing persons at increased risk. Alter et al. are in favor since infected persons can seek treatment, make lifestyle changes to reduce the likelihood of disease progression, and to avoid infecting others. Their striking argument is that hepatitis C is a long-drawn-out disease that requires 20 to 30 years of follow-up to prove that an intervention, such as screening, affects the clinical course of the disease - life expectancy and mortality. In the meanwhile, any intervention would be based on less sounded evidence. In Brazil, estimates point out that up to 5% of the population find been infected(4), and that the first-time blood donors were twice more likely to be infected than usual donors (Odds ratio: 2.0; 95% CI: 1.3–3.0)(5). Data from a waiting list of liver transplant (Hospital Irmandade Santa Casa de Misericórdia, Porto Alegre, RS, Brazil) shows that hepatitis C accounts for 47.8%, hepatitis C plus alcohol for 13%, and hepatitis C plus hepatitis B for 2.3% of the disease (Brandão A, personal communication). Brazilian Government pays for the treatment of hepatitis C, including the highly expensive pegylated interferon, for what there is no evidence that it improves long-term health outcomes3. Therefore, lack of hard endpoints to establish the benefits of screening should be balanced against the costs of paying for the treatment of hepatitis C, as is the case in Brazil. So cost-effectiveness studies are urgently needed. References 1.Alter MJ, Seeff LB, Bacon BR, Thomas DL, Rigsby MO, Di Bisceglie AM. Testing for hepatitis C virus infection should be routine for persons at increased risk for infection. Ann Intern Med 2004;141(9):715-7. 2.Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR Morb Mortal Wkly Rep. 1998;47(RR-19):1-33. Available at http://www.cdc.gov/mmwr/PDF/rr/rr4719.pdf. 3.Calonge N and Randhawa G. Screening for Hepatitis C Virus Infection. U.S. Preventive Services Task Force (USPSTF). Ann Intern Med 2004;141:718–19 4.World Health Organization: Hepatitis C – global prevalence (update). Wkly Epidemiol Rec 2000, 75:17-28 5.Brandao AB, Fuchs SC. Risk factors for hepatitis C virus infection among blood donors in southern Brazil: a case-control study. BMC Gastroenterol 2002;2:18. Conflict of Interest: None declared