Chicago—Researchers are calling for a targeted hepatitis C virus (HCV) screening campaign for all baby boomers. They believe that doing so will significantly cut the burden of HCV-related advanced liver diseases and cancers.

The investigators, who presented estimates of the impacts of such an approach at the 2011 Digestive Disease Week meeting (abstract 477), argued that existing risk-based screening fails to capture people who may have contracted HCV decades ago and are potential carriers of dormant disease, but who do not currently engage in high-risk activity.

A blanket age-based screening protocol among those born between 1945 and 1970 would capture many of these patients, said Anna Lok, MD, who was not involved in the study.

“Screening by birth cohort identifies an age group at the greatest risk for HCV, simplifying the process of screening selection and avoiding the potential issues of patients denying risk factors or physicians forgetting to inquire about risk factors,” said Dr. Lok, director of clinical hepatology and professor in the Department of Internal Medicine, University of Michigan Health Center, Ann Arbor.

Study investigator Lisa McGarry, MPH, director of health economics and outcomes research at Innovus, a branch of Ingenix Life Sciences (Medford, Mass.), said her research team used existing HCV prevalence rates to create a Markov probability model estimating the rates of HCV infection and infection-related liver disease in the baby boomer generation. The model included variables such as rates of spontaneous viral clearance, disease progression, treatment response and state-specific mortality to help predict rates of cures, progressive disease and carcinomas.

Ms. McGarry and her colleagues assumed screening by age group would capture all of the estimated 1.6 million HCV-infected baby boomers in the country if implemented over a five-year period, while a risk-based approach would screen less than 3% of infected individuals (Shatin D et al. Am J Manag Care 2004;10:250-256). Given these assumptions, they estimated an age-based HCV screening approach would reduce the incidence of advanced liver disease in this population by 106,000 cases and related hepatocellular carcinomas by approximately 35,000 cases. Overall, screening by age would result in 7,000 fewer HCV-related liver transplants and 59,000 fewer HCV-related deaths over the generation’s life span.

This five-year screening campaign, however, would cost $45.1 billion, substantially more than the $32 billion that the current risk-based screening program costs. Age-based screening would extend lives at a relatively low cost of $25,279 per quality-adjusted life-year gained.

Co-investigator Zobair M. Younossi MD, MPH, said that treatment outcomes with an age-based HCV screening approach will further improve as newer classes of HCV drugs are introduced in the clinical setting.

“In this particular age group, this is a cost-effective approach to extending HCV infected individuals’ life spans and improving their quality of life,” said Dr. Younossi, vice president for research at Inova Health System, and executive director at the Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, Va.

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