Screening for hepatitis C among injecting drug users and in genitourinary medicine clinics: systematic reviews of effectiveness, modelling study and national survey of current practice

Stein K, Dalziel K, Walker A, McIntyre L, Jenkins B, Horne J, Royle P, Round A
Record ID 32003000026
Authors' objectives:

The aims of this report were to review the clinical effectiveness and cost-effectiveness of screening for hepatitis C virus (HCV) in injecting drug users (IDUs) and genitourinary medicine (GUM) clinic attenders in the UK. Further objectives were to determine the extent of screening for HCV in England and whether knowledge of HCV status causes behavioural changes among infected or uninfected people that may reduce the spread of HCV.

Authors' results and conclusions: Study of current practice in HCV screening (diffusion study): The response rate was 65% overall, and 26% of drug services reported screening compared to 92% of GUM clinics. The survey revealed that a wide range of eligibility criteria for screening are used, with many organisations screening only those considered to be at increased risk of infection. A range of screening tests are reported, although enzyme-linked immunosorbant assay followed by polymerase chain reaction is the commonest combination. Organisations that conduct screening are often not closely associated with those that consider treatment, and this may mean that people are screened who would not be considered for treatment. Alternative reasons for screening under these circumstances are unknown. Health authorities may not be fully aware of the extent of screening locally, which may suggest a lack of strategic overview of screening and that the implications of initiating screening may not have been considered across healthcare communities. Treatment for HCV is widely, although not universally, available. Use of pegylated interferon in combination therapy appears at the time of writing limited. Effect of knowledge on risk behaviour: Four relevant studies were identified (three cross-sectional and one longitudinal) and all had considerable methodological limitations. There was no compelling evidence to support the idea that behavioural changes would occur as a result of learning HCV status, either among those shown to be HCV positive (who may be encouraged to reduce the risk of infecting others) or those shown to be HCV negative (who might consider protecting themselves from infection), although the evidence base was insufficient to reject the possibility that such effects exist.
Authors' recommendations: The objectives of screening for HCV should be clarified. Policy makers might wish to elucidate whether the primary purpose of screening is to: identify infected individuals for treatment, enable monitoring of infected individuals regardless of eligibility for treatment, achieve harm reduction in relation to the progression of HCV disease through reducing alcohol consumption or influence behaviour in relation to the spread of HCV. Evidence in support of objectives other than the treatment of infected individuals appears to be limited. Screening for HCV in IDUs in contact with services is moderately cost-effective (about 30,000/QALY) and reasonably stable when explored in extensive one-way sensitivity analyses. Uncertainty around acceptability of screening and adherence to treatment and the simple nature of our model leads us to recommend caution in accepting this estimate. Universal screening in GUM clinics is less cost-effective and subject to greater uncertainty than screening IDUs in contact with services. Assessment of selective screening policies in the GUM clinic setting is restrained by scarcity of information on the epidemiology of HCV in groups other than IDUs. While selective screening may be more cost-effective and affordable than universal screening, we believe that it remains open to question whether seeking people other than IDUs for screening represents a cost-effective use of NHS resources.
Authors' methods: Systematic review, economic evaluation, survey
Project Status: Completed
URL for project:
Year Published: 2002
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Hepatitis C
  • Mass Screening
  • Sexually Transmitted Diseases
  • Substance Abuse, Intravenous
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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