Next, in those in whom HCV transmission occurred, we were able to model the probability of hepatitis C spontaneous resolution, the benefit of treating acute hepatitis C earlier in the absence of the spontaneous resolution of the infection and the course of CHC disease in the absence of a response to acute hepatitis C treatment
Next, in those in whom HCV transmission occurred, we were able to model the probability of hepatitis C spontaneous resolution, the benefit of treating acute hepatitis C earlier in the absence of the spontaneous resolution of the infection and the course of CHC disease in the absence of a response to acute hepatitis C treatment. Follow-up in the case where a treatment for acute hepatitis C was initiated Treatment for acute hepatitis C was administered for a duration of 6 months.22 A positive HCV RNA test at the end of treatment corresponded to non-response to treatment and the patient was considered to have CHC. quality of life after exposure. Results: For a HCV transmission risk of 0.5% after exposure, the French strategy led to the highest costs/person (181.40) and the baseline-US strategy to Nilvadipine (ARC029) the lowest (126.60) (178.50) for alternative-US). The shortest mean time to HCV contamination diagnosis (1 month) and the lowest number of chronic hepatitis C (CHC) patients (1.9/7300 HCWs exposed) was obtained with the alternative-US strategy (vs 6 months and 7.9 CHC, respectively with baseline-US). Compared with the alternative-US, the French strategy was associated with higher costs and lower utilities, and the European with a higher incremental C/E ratio. Compared with the Nilvadipine (ARC029) baseline-US strategy, the alternative-US strategy C/E ratio was 2020 per quality-adjusted life year saved. Conclusion: In HCWs exposed to HCV, a strategy based on early HCV RNA testing shortens the period during which the HCWs wait for his HCV status, leads to lower risk of progression to CHC and is reasonably cost-effective. Contamination by hepatitis C virus (HCV) is an important occupational hazard for healthcare workers (HCWs). In France, in 2004, 41?276 accidental blood exposures occurred in hospitals, 58.7% of which were percutaneous injuries.1 Of these cases, 6.2% occurred to anti-HCV antibody-positive source patients and 24.1% to source patients whose status was not known but who were considered as potentially anti-HCV antibody positive. In the USA, 1?385?280 sharp injuries were estimated to occur annually, and 22?000 HCWs were exposed to at least one percutaneous injury with a sharp object contaminated with HCV2 (http://www.who.int/quantifying_ehimpacts/publications/en/sharps.pdf). Different follow-up schedules for occupational HCV detection have been recommended in different countries. Whereas European guidelines recommend alanine transaminase (ALT) monitoring alone,3 French and baseline-US guidelines are based on anti-HCV antibody and ALT monitoring,4 5 but alternative-US guidelines propose HCV RNA testing at 4C6 weeks if earlier diagnosis of HCV contamination is desired. The risk of transmission is first determined by the status of the source patient: when the occupational exposure involves an HCV RNA-negative source patient, the risk is considered to be zero; when the source patient is usually HCV RNA-positive, it is estimated at 0C10.3%,6C16 with Nilvadipine (ARC029) an average rate of 0.5%.11 17 The results of a recent caseCcontrol study conducted in five European countries suggested that after occupational exposure to HCV, assessment of the Nilvadipine (ARC029) risk of transmission should take into account the severity of the injury and the device involved.18 Our hypothesis is that follow-up schedules should be tailored to the HCWs risk of HCV seroconversion after percutaneous exposure. In this study, using a cost-effectiveness (C/E) analysis, we compared the three existing follow-up strategies recommended in France, Europe and Nilvadipine (ARC029) the USA after occupational exposure to HCV, with a strategy based on early HCV RNA testing, according to the risk of HCV transmission. MATERIALS AND METHODS Study design We designed a decision analysis model to compare in HCWs exposed to an HCV-positive source the three existing strategies of follow-up and a strategy Cav1 based on early HCV RNA testing: Strategy 1: monitoring of anti-HCV antibodies and ALT activity at months 1, 3 and 6 after HCV exposure, and HCV RNA testing to confirm positive anti-HCV antibody results and/or ALT elevation (French recommendations).4 Strategy 2: monthly monitoring of ALT activity for 4 months after HCV exposure, and of anti-HCV antibodies at month 6, and HCV RNA testing to confirm ALT elevation or positive anti-HCV antibody results (European recommendations).3 Strategy 3: anti-HCV antibody and ALT activity monitoring at month 6 after HCV exposure, and HCV RNA testing to confirm positive anti-HCV antibody results (baseline-US recommendations).5 Strategy 4: HCV RNA testing 1 month after HCV exposure (alternative-US recommendations), as proposed by US recommendations if earlier diagnosis of HCV is desired.5 Baseline anti-HCV antibodies and ALT activity were determined, but, as they were identical for the four strategies, they were not taken into account in this analysis. When the HCV RNA test was unfavorable during follow-up, a second HCV RNA test was requested to confirm the absence of HCV contamination, because undetectable HCV RNA at one time point does not exclude the possibility of HCV contamination.19.