Health and economic consequences of HCV lookback.
BACKGROUND
Several countries have conducted or are considering campaigns of lookback on blood recipients who may have acquired posttransfusion HCV (PT-HCV) before the implementation of anti-HCV screening. There is, however, no estimation of the health and economic consequences of the medical interventions triggered by the lookback.


METHODS
This study used a Monte Carlo simulation of a Markov model representing the natural history of PT-HCV. Unadjusted and quality-adjusted life expectancy and lifetime medical costs were calculated for a cohort of patients in whom PT-HCV is diagnosed through the lookback, and these values were compared with those calculated for a similar cohort on whom lookback is not performed.


RESULTS
The model predicts that 47 percent of people who received transfusions of HCV-infective blood 10 years ago are still alive, carry the infection, and have not yet progressed to end-stage liver failure. In this population, forthcoming complications of PT-HCV will reduce the remaining life expectancy by 1.75 years per patient. Medical interventions triggered by the diagnosis of PT-HCV would salvage 0.123 years of life expectancy, at a net cost of $921 per newly diagnosed patient. The health and economic impact of diagnosing a new case of PT-HCV through lookback was sensitive to the patient's age, the efficacy of antiviral therapies, the time elapsed from transfusion to lookback, and the future inflation of costs of treating end-stage liver disease. Under some plausible assumptions, the intervention could result in net financial savings for the health care system, but it may also produce a net health loss for the majority of patients who will be said to be HCV-positive without being offered an effective therapy.


CONCLUSIONS
Diagnosis of PT-HCV through HCV lookback has a potential both to increase patients' life expectancy and to reduce health care costs. However, more effective antiviral therapies and a better knowledge of factors predicting the progression of PT-HCV are needed to attain those goals. Meanwhile, care should be taken to avoid pursuing a health gain for a minority that might result in a health loss for the majority.
Pereira
A
A
Service of Hemotherapy and Hemostasis and the Blood Bank, Hospital Clinic, Barcelona, Spain. apereira@clinic.ub.es
D001803:Blood Transfusion / Q000191:economics*; D003365:Costs and Cost Analysis; D016174:Hepacivirus; D006526:Hepatitis C / Q000191:economics* / Q000635:transmission*; D006801:Humans; D008390:Markov Chains; D009010:Monte Carlo Method; D065227:Transfusion Reaction