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Press
Releases -- View
current and archived press releases from the Office of
Communications.
Recent releases:
Prevalence of Erectile Dysfunction Increases With Age-- press
release of Tuesday, August 5, 2003
Four in Ten Americans in High-Mosquito Areas Are Not Yet Taking
Precautions Against West Nile/Mosquito Bites-- press release of
Thursday, July 31, 2003
Significant Global Health Gains Could Be Made by Reducing Well-known
Risk Factors-- press release of Friday, July 25, 2003
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As
Testing Campaigns Identify More People With Asymptomatic Hepatitis C
Infection, Benefits, Risks and Cost-Effectiveness of Early Treatment
Uncertain
Women, those infected at young age, certain virus subtypes may
not see great benefit from early therapy
For immediate release: Tuesday, July 8, 2003
Boston, MA - In the first analysis that takes into account the
variety in progression of hepatitis C infection, researchers at
Harvard School of Public Health’s Center for Risk Analysis looking
at the clinical benefit and cost effectiveness of the latest
treatment for the disease have 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 (JAMA) “Cost-Effectiveness of
Treatment for Chronic Hepatitis C Infection in an Evolving Patient
Population.”
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.
The current treatment recommended for HCV is an injected long-acting
interferon plus oral ribavarin. 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.
Previous analyses have found that treating HCV is clinically
beneficial and cost-effective, on average, in patients infected with
HCV and with evidence of existing liver disease. For patients
without evidence of liver damage, the effects of early therapy on
life expectancy and particularly on patient quality of life are less
clear.
In the United States an estimated 2.7 million individuals are
chronically infected with HCV, but many of these people remain
unaware of their infections. Rising interest in HCV from patient
advocacy groups, public health advisory groups, and the lay press
has been accompanied by a range of policy initiatives such as a
government ‘lookback’ campaign launched in 1998 to notify people who
received blood from potentially infected donors and an open letter
from the Surgeon General in July 2000 warning the public about the
‘silent epidemic’ and encouraging at-risk individuals to get tested.
In this analysis, HSPH researchers, led by Joshua Salomon, assistant
professor of international health, looked at a patient population of
HCV seropositive but otherwise healthy individuals-- people with the
mildest form of the disease and the group most likely to be turned
up in larger numbers by the HCV testing campaigns. Additionally, the
researchers examined the latest information on the progression of
the disease in several subgroups of patient by gender, age and other
factors. This data showed that progression is highly variable, and
some 30 to 70 percent of infected individuals may never progress to
liver cirrhosis before dying from other causes.
In women in particular HCV appears to progress especially slowly.
The probability of developing cirrhosis during a 30-year period was
estimated to be between 13 and 46 percent for men and between one
and 29 percent for women. Progression rates to cirrhosis and its
complications are probably also substantially lower among those
individuals infected at relatively young ages.
“Taking into account this lowered assessment of risk for some
groups, the possible toxic side effects of therapy, and the limited
efficacy of current regimens, the benefits of early therapy may not
outweigh the substantial costs and decreases in quality of life for
some individuals,” said Sue Goldie, associate professor of health
decision science and senior author of the paper. “As the pool of
patients eligible for treatment expands to the more general
population, it will be imperative for patients and their physicians
to consider these factors in approaching treatment decisions at the
individual level.”
“Policy makers need to carefully consider the implications that
public health campaigns targeted at HCV will have on the individual
clinical decisions that follow,” said Salomon. “There has been a
huge effort over the last few years to identify people infected with
HCV, but this wider group of patients will likely include those who
are least likely to develop advanced liver disease. For patients at
low risk of progressing, the overall health gain from treatment may
be minimal given the potential for toxic side effects.”
The research was supported in part by a grant to Dr. Salomon from
the former Agency for Health Care Policy and Research. Coauthors
Drs. Goldie, Milton Weinstein and
James Hammitt are members of the Harvard Center for Risk
Analysis and the Department of Health Policy and Management at HSPH.
For further information, please contact:
Robin Herman
Director of Communications
Harvard School of Public Health
677 Huntington Avenue
Boston, Massachusetts 02115
Phone: 617-432-4752
Email:
rherman@hsph.harvard.edu
Harvard School of Public Health is dedicated to
advancing the public's health through learning, discovery, and
communication. More than 300 faculty members are engaged in teaching
and training the 800-plus student body in a broad spectrum of
disciplines crucial to the health and well being of individuals and
populations around the world. Programs and projects range from the
molecular biology of AIDS vaccines to the epidemiology of cancer;
from risk analysis to violence prevention; from maternal and
children's health to quality of care measurement; from health care
management to international health and human rights.
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