Published: June 24, 2013
An influential health advisory group has reversed itself and concluded that all baby boomers should be tested for hepatitis C, meaning that under the new health law many insurance plans will have to provide screening without charge to patients.
The group, the United States Preventive Services Task Force, announced its change of heart on Monday, saying there was likely to be some benefit from such screening.
An estimated 15,000 Americans a year die from the consequences of hepatitis C infection, which can cause liver scarring, liver failure and liver cancer, although such effects typically do not show up for decades, if at all.
About three-quarters of the more than three million Americans with hepatitis C are baby boomers, most of them infected decades ago. But most do not know it because they have no symptoms. Those at highest risk for the infection include users of injected drugs and recipients of blood transfusions before 1992, when screening of donated blood for the virus began.
That finding put it at odds with the Centers for Disease Control and Prevention, which had said a few months earlier that all people born between 1945 and 1965 should be offered a one-time test to see if they are infected with the hepatitis C virus.
But the task force said on Monday that after reviewing some new studies and the public comments that it had received on its preliminary decision, it decided to recommend screening of baby boomers, saying there was a “moderate certainty” it would have a “moderate net benefit.”
The decision is good for drug companies selling or developing drugs to treat hepatitis C, like Merck, Vertex, Gilead and AbbVie, because it means more people who harbor the virus but do not know it will be discovered, making them candidates for treatment. The decision could also help companies that make hepatitis C tests, like OraSure Technologies.
New drugs introduced by Merck and Vertex Pharmaceuticals have increased the cure rates for hepatitis C when used along with existing drugs. Companies including Gilead Sciences and AbbVie are racing to bring drugs to market in the next two or three years that would do away with the need for weekly injections of a harsh drug, alpha interferon.
The task force, which is made up of independent experts appointed by the government, said in its preliminary decision that the C.D.C. might have overestimated how many infected people would develop liver problems or die, thus overstating the benefits of screening.
But in its final decision, the task force said new studies and the growing effectiveness of treatment buttressed the case for screening even those without any symptoms or risk factors.
Many of those who had submitted public comments after the preliminary decision had argued that screening all baby boomers would be more effective than testing only those thought to be at risk, like people who had used injected drugs. Many people either do not remember risky behavior from decades ago or do not want to tell their doctors about it.
The task force’s preliminary recommendation had a grade C, meaning testing could be offered to select patients and would probably have a small benefit. The final recommendation has a grade B, suggesting a moderate benefit.
Under the Affordable Care Act, preventive services that get a grade A or B from the task force are supposed to be provided without co-payments from patients, although some existing health plans are grandfathered in and would be exempt.
Although the task force is considered quasi-governmental — and its recommendations are meant for primary care physicians — it can be ignored. It encountered significant resistance from doctors and other medical experts when it recommended a reduction in mammography screening. It also got criticism over its recommendation against prostate screening, although the American Urological Association eventually reached a similar conclusion.
Legislators in New York State this month passed what advocates called the first state bill that would require hospitals and other health care providers to offer hepatitis C screening. The bill will now go to Gov. Andrew Cuomo for his signature.