Health and economic consequences of HCV lookback

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 inter ventions triggered by the lookback. STUDY DESIGN AMD METHODS: This study used a Monte Carlo simulation of a Mar kov model representing the natural history of PT-HCV. Unadjusted and qualit y-adjusted life expectancy and lifetime medical costs were calculated for a cohort of patients in whom PT-HCV is diagnosed through the lookback, and t hese values were compared with those calculated for a similar cohort on who m lookback is not performed. RESULTS. The model predicts that 47 percent of people who received transfus ions of HCV-infective blood 10 years ago are still alive, carry the infecti on, and have not yet progressed to end-stage liver failure. In this populat ion, forthcoming complications of PT-HCV will reduce the remaining life exp ectancy by 1.75 years per patient. Medical interventions triggered by the d iagnosis of PT-HCV would salvage 0.123 years of life expectancy. at a net c ost 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 patie nt's age, the efficacy of antiviral therapies, the time elapsed from transf usion to lookback, and the future inflation of costs of treating endstage l iver disease. Under some plausible assumptions, the intervention could resu lt in net financial savings for the health care system, but it may also pro duce 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. Howeve r, more effective antiviral therapies and a better knowledge of factors pre dicting the progression of PT-HCV are needed to attain those goals. Meanwhi le, care should be taken to avoid pursuing a health gain for a minority tha t might result in a health loss for the majority.