Benefits, risks and cost-effectiveness of early hepatitis C treatment uncertain

Hepatitis C virus (HCV) is a largely asymptomatic disease that after a long latency period, usually spanning decades, can damage the liver and eventually cause cirrhosis and liver cancer. While it is currently a leading cause of liver transplantation in the U.S., many infected patients will never develop advanced liver disease. HCV infection is most commonly transmitted through shared needle use and also had been passed along through blood transfusions before testing of blood donations largely eliminated that route in the early 1990s. Treatment has improved considerably in the last decade but is still only effective in 40 to 60 percent of patients, has potentially severe side effects (e.g., nausea, severe fatigue, depression and, in some cases, suicidal impulses), and a single 48-week treatment course costs more than $20,000. Researchers at Harvard School of Public Health’s Center for Risk Analysis looked at the clinical benefit and cost effectiveness of the latest treatment for the disease. They concluded that early treatment may not be the right choice for many thousands of people with asymptomatic hepatitis C infection. Their analysis is described in the July 9, 2003 issue of the Journal of the American Medical Association.