This page is an archive. Its content may no longer be accurate and was last updated on the original publication date. It is intended for reference and as a historical record only. For hep C questions, call Help4Hep BC at 1-888-411-7578.
| The Canadian Task Force on Preventative Health Care (CTFPHC) released its HCV Screening Guidelines today in the Canadian Medical Association Journal.
The guidelines make the recommendation to continue screening those with known risk factors, but does not include a recommendation to screen the age cohort born between 1945-1975. This news article quotes the head of the working group for these guidelines: “What we are saying is that people who are not at an elevated risk don’t need to go for a blood test or be screened for hepatitis C,” said Grad, an associate professor of medicine at McGill University with a family practice in Montreal,” Price Dictating Policy The guidelines were published today along with a commentary by Drs. Genevieve Cadieux and Herveen Sachdeva of the Dalla Lana School of Public Health in Toronto, who suggest that “Population-based screening should be reconsidered in light of price reductions for DAAs, as well as emerging evidence on HCV transmission and long-term health outcomes after treatment.” AHC Does Not Endorse CTFPHC HCV Screening Guidelines In fact, we sent this letter, outlining our concerns and disappointment with the final version of the guidelines, making clear that we do not support the guidelines as they stand. |
Dr. Jordan Feld is just one hepatitis specialist who is not a fan of the new guidelines. He writes:
With all the progress in hepatitis C, the biggest challenge in the past couple of years has been trying to obtain these very effective therapies for our patients. It was very exciting in Canada to see recent negotiations with the federal government loosen restrictions and allow us to start treating more people with a promise to have universal access for the country in the next 2 years or even less.
This was fantastic news for patients but was followed shortly by less optimistic news. We now have a guideline from the Canadian Task Force on Preventive Health Care for screening recommendations for hepatitis C in Canada. I must admit that I and many of my colleagues were disappointed to see the conclusions of the task force. They reviewed literature on screening and treatment and concluded that screening should not be done in people at low risk.
That, in itself, is somewhat of a self-evident statement and unfortunately not very helpful. The Canadian Liver Foundation previously advocated for baby boomer screening similar to that in the United States with a slightly different birth cohort of 1945 to 1975. That is based on very solid data in Canada showing this is not only effective in identifying HCV, but it is also cost effective. If the prices on new treatments come down — and they may already be there — this could even be cost-saving for our health care system. Screening makes a lot of sense.
How the task force could look at the data and conclude that we should not be screening and we should simply stick to our old paradigm of screening high-risk individuals is really disconcerting. We know that does not work. It has failed in every country in which it has been attempted and every disease in which it has been implemented. This antiquated recommendation is rather disappointing.
It is hoped that clinicians and academics in Canada will look beyond these guidelines and recognize the evidence supporting broader screening. With this recognition, we can move to include risk-based screening but also to advocate for population-based screening likely based on the birth cohort of 1945 to 1975 so we can identify those with HCV. With improved access to treatment, we can get them cured and reduce the public health burden from this illness.
Jordan Feld, MD, MPH
Scientist, Toronto General Hospital Research Institute
Associate professor of medicine, University of Toronto
