November 10, 2011

Improved, but very expensive, treatments for hepatitis C may result in a broadening of the current HCV screening recommendations, necessitating that patients of a certain age be screened for the viral infection. A recent study, funded by the Centers for Disease Control and Prevention, demonstrates the cost effectiveness of screening baby boomers for HCV (Ann. Intern. Med. 2011 Nov. 4 [epub ahead of print]).

Hepatitis C has a prevalence of about 3%, with middle aged African Americans having up to a 10% infection rate. In addition, screening for the hepatitis C antibody might not be the most cost-effective strategy for case finding. Over the years, in my practice, I have identified patients with hepatitis C by ordering a one-time serum transaminase. Patients with elevated liver enzymes should have an assessment and hepatitis C is a common cause for asymptomatic, unexplained lab abnormalities. Granted, patients with hepatitis C could have normal liver enzymes, but that population of patients that is not showing evidence of active cellular injury, will be at low risk for disease progression and would not be the highest priority candidate for antiviral therapy.

The cost-benefit analysis of future savings would be substantially different for this group compared to infected patients with ongoing transaminase elevations. Finally, the wisdom of universal treatment of hepatitis C patients in their 60’s warrants reflection. Progression to end-stage liver disease takes years, if not decades. Clearly, younger patients get the most benefit from treatment to clear the virus before years of erosive damage ensues. Older, asymptomatic patients might need to have a biopsy to understand if the prophylactic antiviral therapy will provide benefit within his or her expected lifetime. A 63-year-old patient with minimal hepatic damage on biopsy may not benefit from antiviral intervention.

<- Back to: Observation Unit