Premium
Health and economic consequences of HCV lookback
Author(s) -
Pereira Arturo
Publication year - 2001
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1046/j.1537-2995.2001.41060832.x
Subject(s) - life expectancy , medicine , cohort , psychological intervention , population , hepatitis c , blood transfusion , health care , emergency medicine , intensive care medicine , pediatrics , environmental health , nursing , economics , economic growth
BACKGROUND: Several countries have conducted or are considering campaigns of lookback on blood recipients who may have acquired posttransfusion HCV (PT‐HCV) before the implementation of anti‐HCV screening. There is, however, no estimation of the health and economic consequences of the medical interventions triggered by the lookback. STUDY DESIGN AND METHODS: This study used a Monte Carlo simulation of a Markov model representing the natural history of PT‐HCV. Unadjusted and quality‐adjusted life expectancy and lifetime medical costs were calculated for a cohort of patients in whom PT‐HCV is diagnosed through the lookback, and these values were compared with those calculated for a similar cohort on whom lookback is not performed. RESULTS: The model predicts that 47 percent of people who received transfusions of HCV‐infective blood 10 years ago are still alive, carry the infection, and have not yet progressed to end‐stage liver failure. In this population, forthcoming complications of PT‐HCV will reduce the remaining life expectancy by 1.75 years per patient. Medical interventions triggered by the diagnosis of PT‐HCV would salvage 0.123 years of life expectancy, at a net cost of $921 per newly diagnosed patient. The health and economic impact of diagnosing a new case of PT‐HCV through lookback was sensitive to the patient's age, the efficacy of antiviral therapies, the time elapsed from transfusion to lookback, and the future inflation of costs of treating end‐stage liver disease. Under some plausible assumptions, the intervention could result in net financial savings for the health care system, but it may also produce a net health loss for the majority of patients who will be said to be HCV‐positive without being offered an effective therapy. CONCLUSION: Diagnosis of PT‐HCV through HCV lookback has a potential both to increase patients' life expectancy and to reduce health care costs. However, more effective antiviral therapies and a better knowledge of factors predicting the progression of PT‐HCV are needed to attain those goals. Meanwhile, care should be taken to avoid pursuing a health gain for a minority that might result in a health loss for the majority.