A cost-identification analysis of screening and surveillance of hepatitis C infection in a prospective cohort of dialysis patients.

The Center for Disease Control and Prevention (CDC) recommends screening and surveillance of dialysis patients for hepatitis C virus (HCV), but there are limited data on the real life performance of confirmatory tests. We performed a cost-identification analysis of CDC recommendations using a large database of dialysis subjects. Screening and surveillance were performed according to CDC guidelines: enzyme immunoassay (EIA) testing upon entry then biannual surveillance. All positive EIA tests were confirmed by either polymerase chain reaction (PCR) or radioimmunoblot assay (RIBA). A total of 12,563 patients were tested from 1997 to 2004. By EIA, the prevalence of HCV was 8.4% and annual incidence was 0.96%. The prevalence after confirmation by RIBA and PCR was 5.8% and 4.8%, respectively. The annual incidence of hepatitis C confirmed by RIBA and PCR was 0.13% and 0.084%, respectively. Using Medicare reimbursement, the cost to screen and confirm one case of hepatitis C by RIBA was $372 versus $503 by PCR. However, the cost to identify an incident infection increased to $30,594 by RIBA and $48,622 by PCR. In the sensitivity analysis, the cost of identifying incident HCV infection dropped by 50% when the surveillance interval was extended to 1 year or when seroconversion rates for EIA occurred at 2%. Due to high surveillance cost, further studies are necessary to determine optimal intervals and settings.