Digestive Diseases and Sciences

, Volume 53, Issue 4, pp 1093–1099

A Cost-Identification Analysis of Screening and Surveillance of Hepatitis C Infection in a Prospective Cohort of Dialysis Patients

  • Ma Somsouk
  • Deston E. Langfield
  • John M. Inadomi
  • Hal F. YeeJr
Original Paper

Abstract

The Center for Disease Control and Prevention (CDC) recommends screening and surveillance of dialysis patients for hepatitis C virus (HCV), but there are limited data on the real life performance of confirmatory tests. We performed a cost-identification analysis of CDC recommendations using a large database of dialysis subjects. Screening and surveillance were performed according to CDC guidelines: enzyme immunoassay (EIA) testing upon entry then biannual surveillance. All positive EIA tests were confirmed by either polymerase chain reaction (PCR) or radioimmunoblot assay (RIBA). A total of 12,563 patients were tested from 1997 to 2004. By EIA, the prevalence of HCV was 8.4% and annual incidence was 0.96%. The prevalence after confirmation by RIBA and PCR was 5.8% and 4.8%, respectively. The annual incidence of hepatitis C confirmed by RIBA and PCR was 0.13% and 0.084%, respectively. Using Medicare reimbursement, the cost to screen and confirm one case of hepatitis C by RIBA was $372 versus $503 by PCR. However, the cost to identify an incident infection increased to $30,594 by RIBA and $48,622 by PCR. In the sensitivity analysis, the cost of identifying incident HCV infection dropped by 50% when the surveillance interval was extended to 1 year or when seroconversion rates for EIA occurred at 2%. Due to high surveillance cost, further studies are necessary to determine optimal intervals and settings.

Keywords

Decision analysis HCV Hepatitis C Screening Surveillance Epidemiology 

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Ma Somsouk
    • 1
    • 2
  • Deston E. Langfield
    • 3
  • John M. Inadomi
    • 1
  • Hal F. YeeJr
    • 1
    • 3
    • 4
  1. 1.Department of Medicine, GI Health Outcomes, Policy and Economics (HOPE) Research ProgramUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of MedicineHarbor UCLA Medical CenterTorranceUSA
  3. 3.Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA
  4. 4.San Francisco General HospitalSan FranciscoUSA

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