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Age-Based vs Risk Based HCV Screening
 
 
  from jules: again age-based screening should be part of risk-based screening. The reasons many suggest age-based screening: its easer, clinicians & patients can't or do't want to discuss past risk factors, like IV drug use even one time, but these are excuses and take the easy way out. There are as many s 8 million in the US with HCV, at least 5 million, and since we are looking at the prospect of being able to cure all infected people over the next 3-7 years due to the new HCV drugs in development we should educate clinicians, educate consumers & do awareness programs to tell everyone that they may be at risk, consider risk factors and get HCV tested.
 
New research indicates that screening people born between 1946 and 1970 for hepatitis C virus (HCV) instead of current risk-based screening practices is cost effective and could lead to 106,000 fewer cases of advanced liver disease and 59,000 fewer HCV-related deaths. An estimated 1.6 million U.S. residents ages 40 to 64 are infected with HCV but do not know it.
 
The study, "The Impact of Birth-Cohort Screening for Hepatitis C Virus (HCV) Compared with Current Risk-Based Screening on Lifetime Incidence of and Mortality from Advanced Liver Disease (AdvLD) in the United States (US)," was conducted by Ingenix Life Sciences, Baylor University, Inova Health System and the Harvard School of Public Health and was presented Sunday at Digestive Disease Week® (DDW®) in Chicago.
 
The U.S. Preventive Services Task Force currently does not recommend HCV screening of the general population and instead recommends primary-care screening for HCV risk factors, such as intravenous drug use, and testing those at high risk. However, approximately three-quarters of the U.S. HCV-infected population are unaware of their condition, according to the Institute of Medicine. Researchers explored the clinical and cost implications of age-based screening because current risk-based screening practices have had limited success, given the number of undiagnosed cases in the U.S.
 
Hepatitis C testing practices and prevalence in a high-risk urban ambulatory care setting: 'prevalence 3-7 times higher than 1.6% reported by CDC' using risk-based testing..... - pdf attached http://www.natap.org/2011/HCV/021611_04.htm
 
LACK of HCV Education & UNDERSTANDING OF THE DISEASE
 
HIV and HCV health [mis]beliefs in an inner-city community - pdf attached: 'inaccurate understanding of HCV' http://www.natap.org/2011/HCV/021611_03.htm.
 
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Age-Based Hep C Screening May Work Better Than Risk-Based ...

 
May 8, 2011 ... CHICAGO - A targeted, age-based screening program would result in 59000 fewer deaths associated with hepatitis C and advanced liver disease, ...
 
www.internalmedicinenews.com/.../age-based...c-screening...based-screening/0d0cee8463.html - Cached
 
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Baby Boomer Screening for Hepatitis May Show Millions Have Virus
 
Bloomber. By Michelle Fay Cortez - May 8, 2011
 
Screening baby boomers for hepatitis C may uncover millions of infections and prevent 59,000 deaths among aging Americans, many of whom have no idea they may carry the liver-damaging virus, researchers said.
 
Expanded testing would identify people who may have contracted hepatitis C decades ago and never developed symptoms, allowing them to spread the virus, said lead author Lisa McGarry, director of health economics at Ingenix Life Sciences, a unit of UnitedHealth Group Inc. (UNH) The study, presented at the Digestive Disease Week meeting in Chicago, was funded by Cambridge, Massachusetts-based Vertex Pharmaceuticals Inc. (VRTX), which is awaiting U.S. approval of its hepatitis C drug.
 
The study was done to quantify the benefits of broader screening, McGarry said in a telephone interview. The U.S. Preventive Services Task Force ruled against routine screening for hepatitis C in 2004, saying infection rates are low and most people with the virus don't develop serious health problems. Screening is now done for those at high-risk, which identifies less than 5 percent of infected people each year, McGarry said.
 
"The prevalence of infection differs greatly by age, and there is a hump of people in this age group," she said. "It may stem from behaviors and transmission that occurred a long time ago in people who wouldn't be considered high-risk now," including those who received transfusion before blood was routinely checked for the virus, McGarry said.
 
Infection Estimates
 
Researchers estimated the number of people with undetected infections and devised computer models to track how the disease would be expected to progress in them. They compared the results to what should occur based on current screening rates.
 
Universal testing of people born from 1946 to 1970 would identify 1.6 million unknowingly infected Americans, the study found. Treatment would prevent 106,000 cases of advanced liver disease and 59,000 related deaths, the researchers said. The findings were based on results with older drugs, and will be reviewed once new medicines from companies including Vertex and Merck & Co. are available, McGarry said.
 
Focusing on baby boomers, those born from 1946 to 1964, and people a few years younger will identify those most likely to be infected, said researcher Zobair Younossi, executive director of the Center for Liver Diseases at Inova Fairfax Hospital in Virginia. The virus clears up naturally in about 25 percent to 30 percent of people, he said in a telephone interview. Among the remainder, 20 percent develop serious disease, including cirrhosis or cancer, he said.
 
Many people find out they have been infected, perhaps for decades, when they are diagnosed with advanced disease, he said.
 
"If we focus those with the highest prevalence, we'll get the biggest bang for the screening," he said. "If people know they are at risk, they can be screened for liver cancer and detect it early when it is easier to treat."
 
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Experts Propose Age-Based Hepatitis C Testing
 
Screening People Born From 1946 to 1970 Would Prevent Advanced Disease, Model Shows; Other Experts Want More Evidence
 
By Kathleen Doheny
WebMD Health News
Reviewed by Louise Chang, MD
 
May 9, 2011 -- Screening all people born between 1946 and 1970 for the hepatitis C virus would greatly reduce the number of people with advanced liver disease linked with the virus, according to new research.
 
''Current recommendations are to screen high-risk people," says researcher Lisa McGarry, MPH, director of health economics and outcomes research at Ingenix Life Sciences, a health information, technology, and consulting service.
 
Intravenous drug users are considered at high risk.
 
McGarry and her colleagues suggest that all people in the age group known as baby boomers, along with those born a few years after, be screened.
 
Hepatitis C is a contagious liver disease. It ranges in severity. It can be a mild illness that lasts just a few weeks to a more serious, chronic disease that attacks the liver.
 
McGarry presented her research yesterday at Digestive Disease Week in Chicago.
 
The study was funded by Vertex Pharmaceuticals. The company is developing a hepatitis C drug, telaprevir.
 
Otther experts who reviewed the research say the model is not enough information to suggest a change in the recommendation for hepatitis C testing.
 
Hepatitis C Testing: The Disease Model
 
Using a computerized model of disease progression, the researchers projected the outcomes for the age-based screening they propose.
 
They chose the baby boomer population as well as those born a few years after because the hepatitis C infection rate is particularly high among them. According to the researchers, about 1.6 million people in the U.S. aged 40 to 64 are infected but do not know it.
 
The virus is spread primarily through contact with the blood of an infected person, according to the CDC. Most people become infected by sharing needles or other equipment used to inject IV drugs.
 
People who got a blood transfusion before 1992, when screening of the blood supply became available, are also at risk. Less often, people become infected when sharing personal care items such as toothbrushes or razors that have been in contact with an infected person's blood. Infection can occur after having sex with an infected person, but that risk is considered low. The risk becomes greater if a person has multiple sex partners, rough sex, an STD, or HIV.
 
Health care workers who have needlestick injuries when caring for an infected person can also become infected.
 
Using the model, the researchers determined how many people would be infected and undiagnosed without age-based screening. They computed how far the disease would have progressed.
 
Next, they looked at the effect of screening the entire population in that age range. They looked at how screening and detection would affect progression to advanced liver disease, if infected, and to death.
 
Age-based screening is worth it, they conclude.
 
''The age-based screening program could prevent more than 100,000 cases of advanced liver disease and save almost 60,000 lives over the course of the lifetime of this group born from 1946 to 1970," McGarry tells WebMD.
 
It would prevent more than 7,000 liver transplants, McGarry tells WebMD.
 
The eligible population, she estimates, would be about 101 million.
 
The test is a blood test and costs about $30, she says. It detects antibodies to the virus. If that test is positive, a second test is done to confirm.
 
Earlier treatment due to earlier detection would result in a net cost saving to the health care system, the researchers say.
 
Age-Based Hepatitis C Testing: Other Views
 
Currently, the U.S. Preventive Services Task Force, which issues recommendations on testing and other health issues, does not recommend routine testing, says Virginia Moyer, MD, chair of the task force.
 
The recommendation on hepatitis C testing is not technically current, she says, as it was issued in 2004. "Our goal is to update recommendations every five years, sooner if important new evidence becomes available," she tells WebMD.
 
"I think this one has been of lower priority for updating, perhaps because there has not been a lot of new evidence, nor has there been a widespread call for a change. From the point of view of the task force, this is the kind of evidence that might help us move forward with an update."
 
The model alone would not be enough to change the recommendation, says Moyer, who is also professor of pediatrics at Baylor College of Medicine, Houston.
 
"We would not base a recommendation solely on modeling, but we do use modeling to help us understand the trade-offs, which is what these authors are attempting to evaluate," she says.
 
When the task force does take up the issue of hepatitis C testing, "I think this is a piece of information they need to take a look at," says Aaron Glatt, MD, a spokesman for the Infectious Diseases Society of America and president of St. Joseph Hospital in Bethpage, N.Y.
 
He reviewed the findings for WebMD but was not involved in the study.
 
The researchers should refine the model to zero in on those in the age group with the most risk, he says. "There may be ways to knock down that 100 million people to 40 million," he says.
 
For instance, he says, by asking about risk factors in the past, some people may be declared low risk. The key, he says, is for people to think of risk factors from decades ago, not current ones.
 
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Age-Based Screening for Hepatitis C Virus Could Lead to Fewer Cases of Advanced Liver Disease and Related Deaths, According to New Study
 
Age-based screening would extend lives at relatively low cost of $25,279 per quality-adjusted life-year gained;
 
1.6 million U.S. residents ages 40-64 are infected with hepatitis C virus but are undiagnosed;
 
Research presented at Digestive Disease Week 2011 in Chicago
 
Press Release Source: Ingenix On Monday May 9, 2011, 11:48 am EDT
 
CHICAGO--(BUSINESS WIRE)-- New research indicates that screening people born between 1946 and 1970 for hepatitis C virus (HCV) instead of current risk-based screening practices is cost effective and could lead to 106,000 fewer cases of advanced liver disease and 59,000 fewer HCV-related deaths. An estimated 1.6 million U.S. residents ages 40 to 64 are infected with HCV but do not know it.
 
The study, "The Impact of Birth-Cohort Screening for Hepatitis C Virus (HCV) Compared with Current Risk-Based Screening on Lifetime Incidence of and Mortality from Advanced Liver Disease (AdvLD) in the United States (US)," was conducted by Ingenix Life Sciences, Baylor University, Inova Health System and the Harvard School of Public Health and was presented Sunday at Digestive Disease Week® (DDW®) in Chicago.
 
The U.S. Preventive Services Task Force currently does not recommend HCV screening of the general population and instead recommends primary-care screening for HCV risk factors, such as intravenous drug use, and testing those at high risk. However, approximately three-quarters of the U.S. HCV-infected population are unaware of their condition, according to the Institute of Medicine. Researchers explored the clinical and cost implications of age-based screening because current risk-based screening practices have had limited success, given the number of undiagnosed cases in the U.S.
 
"Current risk-based hepatitis C virus screening practices are often limited to people who have symptoms of liver disease or who are considered high risk," said Lisa McGarry, MPH, lead author of the study and director of health economics and outcomes research in Ingenix Life Sciences. "A shortcoming in risk-based screening is that symptoms of the hepatitis C virus might not appear until 20 years or more after an individual has been infected, which is one of the reasons there is a high percentage of undiagnosed cases of HCV. With particularly high hepatitis C infection rates among Baby Boomers, it was important to explore the implications of a targeted, age-based screening approach."
 
Methodology and Findings
 
Researchers used an epidemiologically-based mathematical computer model to project economic and clinical outcomes of an age-based screening program. The model first sought to determine how many people in the United States are currently infected and undiagnosed, and how far the disease is likely to have progressed in this population. Then, researchers examined the implications of implementing a screening program targeted at the "Baby Boomer Plus" birth cohort (people born between 1946 and 1970) vs. the current practice of risk-based screening. Finally, they ran the model forward to the remainder of people's lifetime to see how screening would affect progression to advanced liver disease and mortality.
 
The model suggests the following:
 
* Among approximately 102 million people ages 40-64 in the United States, about 1.6 million are infected with HCV but do not know it. Age-based (or "birth-cohort") screening could lead to 106,000 fewer cases of advanced liver disease and 59,000 fewer HCV-related deaths
 
* Age-based screening would lead to higher overall costs than risk-based screening ($45.1 billion vs. $32 billion), but would yield lower costs related to advanced liver disease ($21.7 billion vs. $25.8 billion)
 
* Age-based screening would also extend lives at a relatively low cost of $25,279 per quality adjusted life-year2 gained a cost comparable to similar diseases.
 
"This study is the first to look at birth-cohort screening outcomes for hepatitis C virus and provides compelling evidence for putting age-based screening guidelines into practice," said Zobair M. Younossi M.D., MPH, vice president for research at Inova Health System and executive director of the Center for Liver Diseases at Inova Fairfax Hospital, Falls Church, Va. "The cost of just over $25,000 per quality-adjusted life-year gained through earlier detection and treatment is below U.S. willingness-to-pay thresholds and compares favorably with the economics of screening for many other serious diseases. These findings are especially encouraging given the potential impact of the new treatments for hepatitis C virus that are on the horizon, which weren't considered in the study."
 
Support for the study was provided by Vertex Pharmaceuticals.
 
About Hepatitis C1
 
Hepatitis C is a contagious liver disease that results from infection with the hepatitis C virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is usually spread when blood from a person infected with the hepatitis C virus enters the body of someone who is not infected.
 
Today, most people become infected with the hepatitis C virus by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, hepatitis C was also commonly spread through blood transfusions and organ transplants.
 
Hepatitis C can be either "acute" or "chronic." Acute hepatitis C virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the hepatitis C virus. For most people, acute infection leads to chronic infection. Chronic hepatitis C is a serious disease than can result in long-term health problems, or even death.
 
There is no vaccine for hepatitis C. The best way to prevent hepatitis C is by avoiding behaviors that can spread the disease, especially injection drug use.
 
About DDW
 
Jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 7-10, 2011, at McCormick Place, Chicago, Ill. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. For more information, visit www.ddw.org.
 
About Ingenix
 
Ingenix, which recently announced it will become OptumInsight, is a leading provider of health information, technology and consulting services. Organizations, institutions, businesses and government agencies that comprise the health care system depend on Ingenix solutions and insights to improve their performance. Visit www.ingenix.com for more information.
 
1 Centers for Disease Control and Prevention, "Hepatitis C Information for the Public": http://www.cdc.gov/hepatitis/C/index.htm
 
2 Quality adjusted life year refers to units of measure of utility which combine life years gained as a result of health interventions/health care programs with a judgment about the quality of these life years. Source: National Information Center on Health Services Research and Health Care Technology (NICHSR), "Glossary of Frequently Encountered Terms in Health Economics": http://www.nlm.nih.gov/nichsr/edu/healthecon/glossary.html
 
 
 
 
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