Sunday, July 15, 2012

A stealthy killer, hepatitis C needs wider screening

If you're a baby boomer, it's possible that you're walking around with hepatitis C and you don't know it.

Especially if you had a blood transfusion before mid-1992 or shared a needle to inject street drugs, hormones, vitamins or steroids — even once — at some point in your youth.

The fact that more than 2 million baby boomers are infected with the virus, more than 15,000 Americans die from hepatitis C-related illness every year, and such deaths are up and are projected to rise even more is why the U.S. Centers for Disease Control and Prevention has proposed that all people born between 1945 and 1965 be tested for hepatitis C.

The viral infection can cause severe liver diseases, including cancer. End-stage liver disease, or cirrhosis, because of chronic hepatitis C is the leading cause of liver transplants in the United States.

The CDC is expected to issue a final recommendation later this year.

Who should be tested?

The Centers for Disease Control and Prevention defines the baby boom generation as people born from 1945 through 1965. The U.S. Census Bureau has a narrower definition: those born from 1946 through 1964. The CDC estimates the number of people who potentially could be tested for hepatitis C at 78.8 million. The Census Bureau's estimated number of people ages 47 to 65 as of this time last year was closer to 76.9 million.

From a health standpoint, “you'd have to be blind not to agree with it,” said Dr. Mark Mailliard, a University of Nebraska Medical Center hepatitis expert. The CDC said the testing could identify more than 800,000 people who have the virus and prevent more than 120,000 deaths.

“The prevalence of chronic hepatitis C is relatively high in the '45 to '65 birth cohort,” said Thomas Hoerger, a medical economist with RTI, an independent, nonprofit institute that provides research and other services to government and commercial clients. That, he said, is due in part “to the fact that this group grew up when there was less control over blood transfusions, in that blood wasn't tested for viruses like hepatitis C or for HIV during the period. And there was more intravenous drug use going on.”

Symptoms of chronic hepatitis C can take up to 30 years to develop, the CDC says, yet damage to the liver can occur during that time. When symptoms do appear, officials say, they often are a sign of advanced liver disease.

Symptoms for both acute and chronic hepatitis C can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, gray-colored stools, joint pain and jaundice.

Many cases of hepatitis C were detected after the 9/11 terrorist attacks, when the country saw a surge in blood donations from first-time donors, said Shane Scharer, Iowa's adult viral hepatitis prevention coordinator.

Donated blood is screened for hepatitis C and other infectious diseases, the American Red Cross says, and any blood that does not pass all lab tests is destroyed.

That doesn't mean that someone seeking a hepatitis C screening should donate blood, Scharer said.

The CDC recommends that people be screened for hepatitis C by physicians who can refer them to a specialist if the test detects the virus. Blood centers don't necessarily do that.

Testing millions of middle-aged Americans for hepatitis C will, of course, cost money. The CDC said testing all baby boomers would cost an estimated $2.3 billion. That cost would be paid by private insurers, through government programs or by the patients themselves.

“At this point everybody's sharpening their pencil and getting out their calculator, looking at costs and benefits,” said Dr. Tom Safranek, Nebraska's state epidemiologist. “I would say right now the jury is totally out whether or not this is going to be a ‘go' or not.”

Testing and treatment, the CDC said, could avert $2.5 billion in medical costs related to the treatment of liver cancer, liver transplants and liver disease.

By itself, that would represent a savings.

But you also have to figure in the cost of the treatment for those found to have the disease.

The newest treatment regimen for hepatitis C, which rids the patient's body of the virus about 75 percent of the time, costs about $60,000 per patient, the CDC says. A report published in the November issue of the Annals of Internal Medicine estimated that nearly 41 percent of the 800,000 newly identified people with the virus would be treated, costing more than $19 billion.

Analysts use a measure called quality-adjusted life-years to determine the value of a given medical treatment, Hoerger said. The measure takes into account both the years of life that are saved and the quality of those years. Anything under $50,000 per quality-adjusted life-year, Hoerger said, is considered preferable.

The hepatitis C testing, according to the report published in November, would come in at $35,700.

Still, the screening will increase overall health care costs, Hoerger said.

“But that's the case with almost all types of medical treatment,” he said. “We hope that prevention is going to save so much that it pays for itself. It usually doesn't, but it provides better outcomes. ... We're willing to pay more for those better outcomes.”

Not everyone who tests positive for hepatitis C will need treatment. Follow-up testing with a physician would be needed to confirm whether the person was currently infected or had had it at some point and naturally cleared it from his or her system, said Jude Dean, Nebraska's viral hepatitis prevention coordinator.

“If you clear that infection, which you can do, you'll still have antibodies that show you were infected,” she said.

People with chronic hepatitis C should be monitored regularly by a physician, the CDC says. They should avoid alcohol because it can cause additional liver damage. They also should check with a health professional before taking any prescription pills, supplements or over-the-counter medications, as they could damage the liver, the CDC says.

If liver damage is present, the person should check with his or her doctor about getting vaccinated against hepatitis A and hepatitis B.

Hepatitis C resources
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