Screening for hepatitis B and hepatitis C: use in the absence of appropriate studies is not clear



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Hepatitis B and hepatitis C are the primary viral infection that is transmitted through the blood, which – often unnoticed – becomes chronic and can irreversibly damage the liver. We are discussing whether regular examination of the general population or individual risk groups could limit these diseases, for example through early identification and treatment or changed risk behavior of the affected. But checking can also have weaknesses, such as triggering fears.

In the case of patients with hepatitis B and C, the benefit to the affected or general population exceeds any deficiencies? The Institute for Quality and Effectiveness in Health (IQWiG) systematically addressed these issues. In May 2018, she published two preliminary reports and discussed them. After assessing the comments received, the institute now presents the final reports. Main result: Lack of relevant evidence, the benefit-benefit ratio of screening hepatitis B and hepatitis C remains unclear.

Modeling studies on a risk group review

IQWiG has also studied current modeling studies. Models differ in their structure, assumptions, modeled time periods, observed effects and anticipated interventions – such as the introduction of a systematic overview, increased treatment and improvement of preventive measures, such as syringe exchange programs.

The relative proportions of these possible measures remain unclear in the reduction of new hepatitis C infections. Screening that does not reach the risk in the group almost entirely can impair the effect, as well as discontinuation of treatment or re-infection after treatment. The question of the extent to which the assumptions used in these models are also used in the German supply context remain largely open.

Nevertheless, modeling studies show that screening for injection of drug users could significantly reduce the long-term prevalence of hepatitis C if infected are subsequently treated and receiving treatment in order to prevent the spread of the infection.

Recommendation for recommended hepatitis C is recommended

In addition to studies, IQWiG also assessed the current guidelines. Recommendations of guidelines for the screening of risk groups for hepatitis B are based on assumptions that are incomprehensible.

On the other hand, some guidance on hepatitis C creates probable assumptions about the possible advantages and disadvantages of screening for vulnerable groups and specific birth groups, and on that basis they oppose the examination of hepatitis C limited to these groups. If such a review of risk groups for hepatitis C is introduced, it should be evaluated as important to minimize ambiguity and, if necessary, to quickly change the program.

Requirements for the prepared evaluation

The central registration of all persons involved in the review, and complete monitoring. It is also necessary to assess the extent of the risk involved in screening.

Among other things, it is necessary to estimate the number of liver biopsies, initiated antiviral drugs, comprehensive therapy, adverse reactions, and those with sustained virologic response. At least one random sample must also cover the quality of life associated with health in the years following the test or the onset of treatment. The level of reinfection and the reasons for re-infection should also be determined.

Whether and how much screening and post-treatment actually reduces the prevalence of hepatitis C, it would be easiest to determine if there is a control group. To this end, systematic reviews of risk groups could be introduced in individual pilot regions, while data from other regions could be used for comparison.

idw 2018/11

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