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Aged-based screening bested risk-based screening in liver disease
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A targeted age-based screening program among those born between 1946 and 1964 reduced lifetime cases of advanced liver disease, transplant and mortality associated with liver disease when compared with a risk-based screening program, according to data presented here.
Previous research has identified high prevalence of hepatitis C (HCV) among those born between 1946 and 1964, who may have contracted HCV decades ago and are no longer identified as high-risk, according to background data in the abstract.
For this reason, Gary L. Davis, MD, of Baylor University Medical Center, and colleagues set out to assess the health effect of HCV screening among the targeted US baby boomer population. A run-in period (1964-2010) was established to determine the current HCV infection rates in this population by estimating published age and gender-specific rates of infection.
Acceptance of current risk-based screening differed by HCV infection status and gender. Males accounted for 2.83%, whereas females accounted for 2.92%. After the run-in period, approximately 80,626,900 had no diagnosis of HCV and, therefore, were eligible for screening.
Compared with lifetime risk-based screening, results indicated that the birth-cohort screening strategy resulted in 55,400 fewer cases of decompensated cirrhosis, 31,100 fewer cases of hepatocellular carcinoma and 6,200 fewer cases of liver transplant.
Overall, there were 50,300 fewer deaths associated with HCV infection and advanced liver disease with birth-cohort screening when compared with risk-based screening (229,900 vs. 280,200).
For more information:
- McGarry L. #477. Presented at: Digestive Disease Week 2011; May 7-10; Chicago
Disclosure: Dr. Davis received grant/research support from BMS, Genentech, Schering, Tibotec, Vertex Zobair.
The authors of this study, which examined the benefit of birth cohort screening for hepatitis C, as opposed to risk-based screening, deserve commendation. We’ve learned from addressing the challenges of the HIV epidemic that risk-based screening just doesn’t work well in most medical settings. Routine screening algorithms based on demographic factors are easier to implement, less stigmatizing and more effective. We need to refine our knowledge of the best approaches to hepatitis C screening. Age is only one factor. Prevalence of hepatitis C varies widely by geography and potentially by gender. Hepatitis C infects almost four times as many Americans as HIV. Improved screening for hepatitis C is needed and will result in significant health benefits.
– Timothy P. Flanigan, MD
Rhode Island and the Miriam Hospitals
Disclosure: Dr. Flanigan reports no relevant financial disclosures.
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