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Las Vegas,
NV— Hepatitis C antibody screening has the potential to
provide substantial health benefits at an acceptable incremental
cost, Thomas M. Shehab, MD, said at the annual meeting of the American
College of Gastroenterology.
However, screening cannot be recommended at this time because of
unresolved clinical issues: the rate of progression of hepatitis
C and compensated cirrhosis remains controversial; no one has yet
proven that clearing the virus translates into an improvement in
life expectancy; and, the cost-effectiveness of population-based
screening is unknown, he said.
Risk factors
Current data suggest that most people are not diagnosed based on
risk factors.
“Up to 20 per cent of patients, even within clinical trials,
do not have an identifiable risk factor,” said Dr. Shehab,
Resident in Gastroenterology, University of Michigan, Ann Arbor.
“In addition, doctors in a primary care setting rarely ask
about hepatitis C risk factors. Finally, patients are often evasive
or deny risk factors that may have occurred 20 or 30 years ago that
may have led to a chronic infection.”
Analytic model
Using a Markov simulation, Dr. Shehab and colleagues have estimated
that HCV screening would cost $10,800 (U.S.) per quality adjusted
life year saved—well below the $50,000 threshold.
Importantly, he said, therapy does not need to be 100 per cent.
“If you assume that viral clearance translates into increased
life expectancy, only about 30 per cent of patients screened need
to regain normal life expectancy for this model to be effective.”
The model examined three rates of progression in a population of
45-year-old Americans: indolent (two per cent), base-case (10 per
cent), and aggressive (20 per cent).
In the base-case analysis, all screened patients underwent antibody
testing ($27 U.S.) and those who tested positive underwent PCR testing
for chronic infection ($66 U.S.). Those who were PCR positive with
evidence of hepatic fibrosis received interferon/ribavirin therapy.
After six months of therapy clearance rates were 28 per cent for
genotype 1 and 69 per cent for non-genotype 1 patients. It was assumed
that all patients with sustained response six months after completion
of therapy had a similar life expectancy to non-HCV patients.
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