Hepatitis C screening strategies in hemodialysis patients

Hepatitis C virus (HCV) infection is common in patients undergoing chronic hemodialysis, with an estimated yearly incidence of 0.2% and prevalence bet ween 8% and 10%, Although a screening strategy based on alanine aminotransf erase (ALT) values is currently recommended, this strategy has not been eva luated for cost-effectiveness compared with other potential screening strat egies. A comparison therefore was made using a decision-analysis model of a simulated cohort of 5,000 hemodialysis patients followed up for 5 years. U sing direct medical costs, three strategies were evaluated, including: (1) ALT values with confirmatory testing (biochemical), (2) serial enzyme-linke d immunosorbent and strip immunoblot assay testing (serological), and (3) p olymerase chain reaction (viral), Under baseline assumptions, the per-patie nt cost of screening hemodialysis patients for HCV was $378 for biochemical -based testing, $195 for serological-based testing, and $696 for viral-base d testing. Our model was robust when varying the costs of testing, as well as the incidence and prevalence of HCV infection. Results of sensitivity an alysis by varying costs, HCV incidence, and HCV prevalence indicated that s erological-based screening was less costly than biochemical testing. Bioche mical testing was in turn less costly than viral-based screening. Serologic al-based testing was also more effective in the diagnosis of de novo HCV in fection, with a likelihood ratio of 85, in contrast to the likelihood ratio of 44 with biochemical-based testing using viral-based screening as the go ld standard. A serological-based screening strategy is less costly and more effective than biochemical-based screening in the diagnosis of de novo HCV infection. Serological-based screening should be considered for HCV screen ing in hemodialysis populations. (C) 2001 by the National Kidney Foundation , Inc.