CHICAGO - A targeted, age-based screening program would result in 59,000 fewer deaths associated with hepatitis C and advanced liver disease, compared with the current risk-based screening program, based on statistical modeling.
Under current U.S. screening practices, “people with no risk factors might not get screened,” Dr. Zobair Younossi of the Inova Health System in Fairfax, Va., said during a press conference in advance of the meetingannual Digestive Disease Week. The results were presented at the annual Digestive Disease Week meeting on May 8.
Individuals with hepatitis C may not show symptoms until decades after they have been infected, he noted. Recent studies have shown that the prevalence of hepatitis C virus (HCV) infection among the “baby boomer plus” population (people born in 1946-1970) in the United States may be higher than expected. “A screening strategy based on age, rather than risk factors, could have a significant impact” on the disease, he said.
Dr. Younossi and colleagues used a Markov model of the natural history of the infection and its complications. They applied the model to a population of approximately 102 million individuals who were eligible for screening, and found that the birth cohort screening (BCS) strategy would result in 59,000 fewer deaths related to HCV infection and 106,000 fewer cases of advanced liver disease, compared with the current risk-based screening (RBS) strategy.
The investigators designed a mathematical model using a birth cohort of individuals who were born in the United States in 1946-1970. They estimated the current hepatitis C status and stage of disease progression using a run-in period from 1964 to 2010, as well as using age- and sex-based rates of infection, progression, and spontaneous clearance. BCS involved the assumption that 100% of the cohort would be screened within the first 5 years, starting in 2010.
The model suggested that BCS would cost approximately $25,000 for each additional quality-adjusted year of life gained. BCS would cost more overall than RBS ($45.1 billion vs. 32.0 billion), but BCS would yield lower costs related to advanced liver disease ($21.7 billion vs. $25.8 billion), Dr. Younossi said. The up-front investment could be worthwhile in terms of reducing long-term medical costs, he said.
“There are better hepatitis C treatments in development that could increase the benefits of screening,” Dr. Younossi said. Effective screening for hepatitis C now may reduce future costs to Medicare, he added.
I have checked the following facts in my story: (Please initial each.)
The study was supported by Vertex Pharmaceuticals. Dr. Younossi has served on advisory committees or review panels for multiple pharmaceutical companies, including Vertex Pharmaceuticals, Salix Pharmaceuticals, and Tibotec.
*This story has been updated and new information has been added.
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How Does this Fit into Practice?
It seems intuitive
that screening a cohort of patients, in this case those born between 1946 and
1964, for hepatitis C virus (HCV) infection, treating the ones infected, and
then following them for the next 6 to 34 years (until they reach age 70 years)
should find that the eventual prevalence of complications of end-stage liver
disease would be reduced when compared to the same cohort of patients only
tested for HCV infection when a risk factor for HCV infection is identified.
But how does this information help me as an individual practitioner? Should I
now screen all the “baby boomers” in my practice whether I have identified a
past risk for HCV infection or not? What about patients in other age cohorts?
And how do I reconcile this against the recommendation of the U.S. Preventive
Services Task Force that has yet to change its stand that the available data
doesn’t support HCV screening of high-risk individuals?
One thing that I
believe it does tell me is that we don’t always ask the right questions of our
patients and that patients don’t always remember or tell us about things of the
past that have put them at risk for HCV. Sometimes I simply show my patients a
list of risks and only ask if there is something on the list that might be
true. It saves them from having to own up to a specific event and yet it lets
me know they are at risk and should be screened. I wonder how that approach
would fare when studied.
Rowen K. Zetterman, M.D. is an internist
and gastroenterologist and dean of the Creighton
University School
of Medicine in Omaha, Neb. He serves on the editorial advisory
board for Internal
Medicine News. He reported having no conflicts of interest.
05/08/11 FROM THE ANNUAL DIGESTIVE DISEASE WEEK
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Vitals
Major Finding: BCS
would result in 59,000 fewer deaths related to HCV infection and 106,000 fewer
cases of advanced liver disease, compared with RBS.
Data Source:
Investigators applied a Markov model to a population of approximately 102
million individuals who were eligible for HCV screening.
Disclosures: The
study was supported by Vertex Pharmaceuticals. Dr. Younossi has served on
advisory committees or review panels for multiple pharmaceutical companies,
including Vertex Pharmaceuticals, Salix Pharmaceuticals, and Tibotec.
Age-Based Hep C Screening May Work Better Than Risk-Based Screening
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