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Liver biopsy rates varied widely for VA patients

The use of liver biopsy among Veterans Affairs patients with HCV has declined in recent years, and its frequency is related to a large number of nonclinical factors, according to recent results.

A retrospective analysis incorporated data from the Veterans Affairs (VA) HCV registry from 1997 to 2006 on 171,893 patients with chronic HCV. Evaluated information included antiviral treatment indicators, contraindications, number of doctor visits and demographics. Researchers conducted the study to determine predictive factors for the use of liver biopsy to assess liver damage.

From 1997 to 2006, biopsies were performed on 28,677 VA patients (16.7%) with confirmed HCV. The frequency of biopsies increased from 1997 (475 procedures) through 2004 (4,758 procedures) but declined in subsequent years. From 2004 to 2006, frequency varied from 5% to 18% among the 21 VA regions, and this variability remained significant independent of other factors, including time spent with a specialist and the amount of healthcare visits.

Biopsies were significantly associated with a number of contraindications, including substance use disorder, depression and other psychiatric disorders, HIV, hypertension, heart failure, diabetes and cirrhosis, among others (P<.001). Other characteristics significantly associated with biopsies included advanced age, lower BMI and race/ethnicity, with non-Hispanic whites more likely to receive a biopsy than others (P<.001).

“Liver biopsy rates in the VA system have variability that seems unrelated to clinical need,” the researchers wrote. “New antiviral therapies and noninvasive assessment techniques may create additional uncertainty for the role of liver biopsy, perhaps explaining its decline in recent years. … Future research and policy should focus on developing more detailed guidance on the use of liver biopsy among HCV-infected patients.”