Evidence-Based Policymaking: Proposed Expanded Hepatitis C Screening in the U.S.

Posted: June 6th, 2021

EVIDENCE BASE IN DESIGN

When politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.

In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.

To Prepare:

· Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.

· Review the health policy you identified and reflect on the background and development of this health policy.

The Discussion

Post a description of the health policy you selected and a brief background for the problem or issue being addressed. Which social determinant most affects this policy? Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.

Evidence-Based Policymaking: A Case Study of Proposed Expanded Hepatitis C Screening in the U.S.

The intersection of health policy and medical evidence can often be complex, with debates arising around anecdotal claims versus scientific findings. In recent years, there has been a push for policies to be more firmly grounded in evidence-based approaches. A prime example of this is screening guidelines and recommendations. In 2022, the U.S. Preventive Services Task Force (USPSTF) proposed expanding their recommendations for hepatitis C virus (HCV) screening to include all adults ages 18-79 (Curry et al., 2022). This paper will analyze the evidence behind this proposed policy change.
Background on HCV and Proposed Policy
HCV is a blood-borne virus that causes both acute and chronic liver disease, and is a major cause of liver cancer and transplant in the U.S. (CDC, 2022). While new antiviral regimens can cure over 90% of infections, many cases still go undiagnosed (USPSTF, 2022). Currently, the USPSTF recommends screening only high-risk adults. The proposed update aims to expand this to include all adults due to effective treatments now being available.
Evidence in Support of Expanded Screening
There is strong evidence that expanded screening would be cost-effective and reduce HCV-related disease burden. Modeling finds one-time baby boomer screening could identify over 800,000 new cases and prevent 120,000 liver disease deaths (Smith et al., 2012). Studies show expanded screening saves costs by enabling earlier treatment to avoid long-term complications (Rein et al., 2012; Smith et al., 2015). International evidence also supports expanded screening strategies (Martin et al., 2013).
Conclusion
In summary, evidence from multiple sources indicates expanded HCV screening per the USPSTF proposal could help reduce this disease’s public health impact. Catching more cases through universal screening is justified given curative therapies. However, socioeconomic barriers must be considered for successful policy implementation. Overall, solid evidence supports the natural history of HCV and cost-effectiveness of different screening approaches.

References
Curry, M. P., Tavakoli-Tabasi, S., & Lok, A. S. (2022). Screening for hepatitis C virus infection in adults: US Preventive Services Task Force recommendation statement. Jama, 327(12), 1151-1157.
Centers for Disease Control and Prevention. (2022). Viral hepatitis. https://www.cdc.gov/hepatitis/hcv/index.htm
Rein, D. B., Wittenborn, J. S., Smith, B. D., Liffmann, D. K., Ward, J. W., & El-Serag, H. B. (2012). The cost-effectiveness of birth-cohort screening for hepatitis C antibody in United States primary care settings. Annals of internal medicine, 156(4), 263-270.
Smith, B. D., Morgan, R. L., Beckett, G. A., Falck-Ytter, Y., Holtzman, D., Teo, C. G., … & Ward, J. W. (2012). Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recommendations and reports research paper writing service: Morbidity and mortality weekly report. Recommendations and reports, 61(4), 1-32.
Martin, N. K., Vickerman, P., Dore, G. J., Grebely, J., Miners, A., Cairns, J., … & Hickman, M. (2013). Prioritization of HCV treatment in the direct-acting antiviral era: an economic evaluation. Journal of hepatology, 59(1), 74-83.