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Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
1. Define decision analysis.
2. Select best hepatitis C testing strategy for specific settings.
Background:
Public health clinics, physicians in private practice, and health maintenance organizations are faced with identifying the best method of testing for hepatitis C. This paper compares nine strategies for determining antibody and viral status.
Methods:
Decision analysis compared strategies on cost, sensitivity and specificity. Parameters in the decision tree included risk of hepatitis C, sensitivity, specificity, and cost of individual tests.
Results:
Selection of an optimal strategy involves tradeoffs between cost, maximizing the identification of true positives and reducing false positives. A strategy that involves three blood tests is the best for lower risk patients (cost = $11.12 per individual tested when prevalence is 5%; antibody sensitivity/specificity = 0.94/1.00): first test for prior exposure to hepatitis C using an enzyme immunoassays (EIA); if that test is inconclusive, confirm the test using a different antibody test (recombinant immunoblot assays - RIBA); if either of those tests are clearly positive, test for active virus (reverse transcription polymerase chain reaction - PCR). A strategy that involves only two blood tests is the best for higher risk patients (average cost = $24.33 per individual tested when prevelance is 25%; antibody sensitivity/specificity = 0.94/0.99): first test for prior exposure to hepatitis C using EIA; if positive, test for active virus (PCR).
Conclusions:
The use of these strategies can minimize costs and maximize the likelihood of an accurate diagnosis. The strategy that involves EIA, RIBA, and PCR is appropriate for lower risk individuals. The strategy that involves only EIA and PCR is most appropriate for higher risks groups (those with prior transfusion, IV drug use, abnormal liver test).
See more of Poster Session #2
See more of The 2005 National Viral Hepatitis Prevention Conference