U.S. Preventive Services Task Force*
This statement summarizes the U.S. Preventive Services Task Force (USPSTF) recommendations on screening for hepatitis C virus (HCV) infection, which are based on the USPSTF's examination of evidence specific to asymptomatic persons for HCV testing and treatment. The complete information on which this statement is based, including evidence tables and references, is available in the accompanying article in this issue and in the summary of the evidence and systematic evidence review on this topic. The complete USPSTF recommendation statement (which includes a brief review of the supporting evidence), the accompanying journal article, and the complete systematic evidence review are available through the USPSTF Web site (www.preventiveservices.ahrq.gov). The journal article and the USPSTF recommendation statement are available in print through the Agency for Healthcare Research and Quality Publications Clearinghouse (telephone, 800-358-9295; e-mail, firstname.lastname@example.org).
*For a list of the members of the U.S. Preventive Services Task Force, see the Appendix.
Appendix Table 1.
Appendix Table 2.
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Sandra C Fuchs
Associate Professor, Social Medicine Department, Universidade Federal do Rio Grande do Sul
November 7, 2004
Cost-effectiveness of screening for Hepatitis C
Alter MJ and collaborators(1)commented the recently published guidelines for HCV testing from Centers for Disease Control and Prevention (CDC)(2) and the U.S. Preventive Services Task Force (USPSTF)(3). They highlighted the lack of consensus of the USPSTF (not in favor or against) and CDC (in favor) of testing persons at increased risk. Alter et al. are in favor since infected persons can seek treatment, make lifestyle changes to reduce the likelihood of disease progression, and to avoid infecting others. Their striking argument is that hepatitis C is a long-drawn-out disease that requires 20 to 30 years of follow-up to prove that an intervention, such as screening, affects the clinical course of the disease - life expectancy and mortality. In the meanwhile, any intervention would be based on less sounded evidence.
In Brazil, estimates point out that up to 5% of the population find been infected(4), and that the first-time blood donors were twice more likely to be infected than usual donors (Odds ratio: 2.0; 95% CI: 1.3"“3.0)(5). Data from a waiting list of liver transplant (Hospital Irmandade Santa Casa de MisericÃ³rdia, Porto Alegre, RS, Brazil) shows that hepatitis C accounts for 47.8%, hepatitis C plus alcohol for 13%, and hepatitis C plus hepatitis B for 2.3% of the disease (BrandÃ£o A, personal communication). Brazilian Government pays for the treatment of hepatitis C, including the highly expensive pegylated interferon, for what there is no evidence that it improves long-term health outcomes3. Therefore, lack of hard endpoints to establish the benefits of screening should be balanced against the costs of paying for the treatment of hepatitis C, as is the case in Brazil. So cost-effectiveness studies are urgently needed.
1.Alter MJ, Seeff LB, Bacon BR, Thomas DL, Rigsby MO, Di Bisceglie AM. Testing for hepatitis C virus infection should be routine for persons at increased risk for infection. Ann Intern Med 2004;141(9):715-7.
2.Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR Morb Mortal Wkly Rep. 1998;47(RR-19):1-33. Available at http://www.cdc.gov/mmwr/PDF/rr/rr4719.pdf.
3.Calonge N and Randhawa G. Screening for Hepatitis C Virus Infection. U.S. Preventive Services Task Force (USPSTF). Ann Intern Med 2004;141:718"“19
4.World Health Organization: Hepatitis C "“ global prevalence (update). Wkly Epidemiol Rec 2000, 75:17-28
5.Brandao AB, Fuchs SC. Risk factors for hepatitis C virus infection among blood donors in southern Brazil: a case-control study. BMC Gastroenterol 2002;2:18.
U.S. Preventive Services Task Force*. Screening for Hepatitis C Virus Infection in Adults: Recommendation Statement. Ann Intern Med. 2004;140:462-464. doi: 10.7326/0003-4819-140-6-200403160-00013
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Published: Ann Intern Med. 2004;140(6):462-464.
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