Hepatitis B and hepatitis C are predominantly viral infections transmitted via the blood, which – often unnoticed – become chronic and can irreversibly damage the liver. It is discussed whether a regular screening of the general population or individual risk groups can cure these diseases, for example, by early identification and treatment or a change in risk behavior in the victims. But screening can also have disadvantages, such as triggering fears.
In Hepatitis B and C do the benefits to the affected or general population exceed the potential disadvantages? The Institute for Quality and Efficiency in Health Care (IQWiG) has systematically taken a stand on these issues. In May 2018, it had published two preliminary reports and put them up for discussion. After evaluating the comments received, the Institute is presenting its final reports. The main result: The lack of meaningful evidence is that the distribution between hepatitis B and hepatitis C injury is insufficient.
Modeling studies on risk group screening
IQWiG has also investigated current modeling studies. The models differ in their structure, assumptions, modeled periods of time, identified effects and intended actions – such as the introduction of systematic screening, increased treatment rates, and improvement of prevention measures such as splash replacement programs.
The relative proportions of these possible measures are still unclear in the reduction of new hepatitis C infections. Screening that almost does not reach the risk group may weaken 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 also concern the German supply context are still largely open.
Nevertheless, modeling studies suggest that screening for injections may significantly reduce the long-term occurrence of hepatitis C, if those infected are subsequently treated and treated to prevent the spread of the infection.
Guideline recommendation for hepatitis C plausible
In addition to studies, IQWiG has also evaluated current guidelines. The guidelines for screening of risk groups for hepatitis B are based on assumptions that are incomprehensible.
On the other hand, some hepatitis C guidelines provide reasonable assumptions about possible benefits and disadvantages of screening for risk groups and specific birth cohorts, and oppose the fact that screening for hepatitis C is limited to these groups. If such screening of hepatitis C risk groups is introduced, a follow-up evaluation would be important to reduce the ambiguity presented and to quickly modify the program if needed.
Requirements for an accompanying evaluation
Central is the registration of all persons participating in the screening and a complete follow-up. It should also be calculated which percentage of risk groups actually participated in the screening.
The number of liver biopsies, the antiviral therapies that have begun, the completed therapies, the side effects and those with a continued virological response should be assessed. At least one random test should also cover the health-related quality of life over the years after the test or the start of treatment. The rate of reinfection and the causes of reinfection should also be determined.
Whether and how much screening and subsequent treatment actually reduces the presence of hepatitis C would be easiest to determine if there was a control group. To this end, systematic risk group screening could initially be introduced into individual pilot areas and the figures from other regions could be used for comparison.