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De novo HBV infection in a M ayo C linic hemodialysis population: Economic impact of reduced HBV testing and a call for changes in current US CDC guidelines on HBV testing protocols
Author(s) -
Onuigbo Macaulay A. C.,
Onuigbo Nyelum T. C.
Publication year - 2012
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/j.1542-4758.2012.00748.x
Subject(s) - medicine , hbsag , cohort , hepatitis b virus , hemodialysis , population , hepatitis b , retrospective cohort study , immunology , virology , environmental health , virus
H emodialysis ( HD ) exposes end‐stage renal disease patients to significantly higher risks for H epatitis B V irus ( HBV ) infection, a major public health scourge. Therefore, current US CDC guidelines, last revised in 2001, call for monthly HbsAg tests. The charge to M edicare per HbsAg test is $100. In an economic analysis, we hypothesized that in the new environment of M edicare F ee B undling, this is unwise and wasteful if de novo HBV infection rate among HD patients is <1%. We determined de novo HBV infection rate among a M ayo C linic HD cohort, J uly 2000– J uly 2010. A retrospective analysis of all relevant medical records of the cohort was completed to identify de novo HBV infection. Nine hundred sixty‐five HD patients were analyzed. One case of de novo HBV infection was identified in a 54‐year old known IV drug user, a previous H epatitis C carrier. This translates to a de novo HBV case incidence rate of 0.1%. De novo HBV infection among HD patients in the US , 2000–2010, is only 0.1%. In the early 1970s, rates were as high as 30%. We recommend 3‐monthly HbsAg testing, but to continue current monthly testing for IV drug users and other high‐risk groups. Huge cost savings would result, without any compromise of quality outcomes. With over 500,000 HD patients, this represents a mind‐boggling $40 billion savings in Medicare charges over 10 years. The US CDC should revise these outdated guidelines, last revised in 2001, to fall in line with current clinical realities on the ground.