for HCV Based on Age, Not Risk Factors
More people with chronic hepatitis C could be identified and
treated if healthcare providers routinely screen all "baby
boomers plus" born between 1946 and 1970, rather than
only people traditionally considered at risk.
hepatitis C virus (HCV) infection
typically takes years or decades to progress to severe liver disease.
Many people now developing cirrhosis
or liver cancer
were infected as young adults in the 1960s-1970s, when HCV was not
yet identified and experimentation with drugs was more common.
providers generally offer HCV testing to people thought to be at
risk, including current or recent injection drug users, people who
received blood transfusions before donated blood was adequately
screened, and others with known or suspected exposure. The U.S.
Preventive Services Task Force does not recommend screening for
But this approach may not identify everyone at risk, leaving a significant
number of people with undiagnosed and untreated infection, according
to a study by Lisa McGarry and colleagues presented at the Digestive
Disease Week meeting (DDW) this week in Chicago. Funding for the
research was provided in part by Vertex Pharmaceuticals, which is
developing the new HCV protease inhibitor telaprevir
Approximately three-quarters of people with HCV are not aware they
are infected, and many will not be diagnosed until they are symptomatic,
at which point treatment is less effective, the researchers noted
as background. It is estimated that less than 3% percent of infected
individuals are screened each year.
team compared mathematical models of targeted HCV screening based
on birth year versus current risk-based screening. The birth cohort
screening model assumed that everyone born between 1946 and 1964
-- the "baby boomer" generation -- would be screened once
over a 5-year period, regardless of risk factors or liver disease
symptoms. Another model looked at a larger "baby boomer plus"
cohort of people born between 1946 and 1970. The researchers assumed
that 24% of people would be treated with standard interferon-based
therapy at the time of diagnosis, about one-third would be ineligible
for treatment, and 10% of untreated people would start therapy each
1946-1964 birth cohort approach would screen about 79 million
people vs 8 million using the risk-based approach.
than 1.3 million people would be diagnosed as having HCV using
the former approach compared with about 427,000 using the current
472,000 vs 234,000 people, respectively, would undergo hepatitis
404,000 vs 124,000, respectively, would achieve sustained virological
response, or a cure.
of liver disease outcomes would decrease with expanded screening:
cirrhosis: 112,881 fewer cases;
cirrhosis: 52,787 fewer cases;
carcinoma: 28,634 fewer cases;
transplants: 5,914 fewer cases;
deaths: 47,953 fewer cases.
Screening the "baby boomer plus" cohort would result
in approximately 106,000 fewer cases of advanced liver disease
and about 59,000 fewer HCV-related deaths.
screening would cost more than risk-based screening ($45.1 billion
vs $32.0 billion), but would reduce expenses related to advanced
liver disease ($21.7 billion vs $25.8 billion).
of new direct-acting anti-HCV drugs, which increase the cure rate
when added to pegylated interferon/ribavirin, would lead to even
greater reductions in advanced liver disease and death if age-based
screening were implemented, the researchers noted.
"Screening is potentially a smart investment, comparable to
widely accepted preventive health practices," McGarry said
in a press release issued by DDW. "In particular, screening
for HCV now may reduce future costs to Medicare."
Investigator affiliations; i3 Innovus, Medford, MA; Baylor University
Medical Center, Dallas, TX; Inova Health System, Falls Church, VA;
DiVita Clinical Research, Boston, MA; Harvard School of Public Health,
McGarry, GL Davis, ZM Younossi, et al. The Impact of Birth-Cohort
Screening for Hepatitis C Virus (HCV) Compared with Current Risk-Based
Screening on Lifetime Incidence of and Mortality from Advanced Liver
Disease (AdvLD) in the U.S. Digestive Disease Week (DDW 2011). Chicago.
May 7-11, 2011. Abstract 477.
Digestive Disease Week. Investigators Make Great Strides in Identifying
and Improving Screening Practices and Treatment for Liver Related
Diseases. Press release. May 8, 2011.