Efectividad clínica, seguridad y evaluación económica del cribado poblacional de hepatitis C. Revisión Sistemática.
Authors: Llanos-Méndez Aurora , Molina-Linde Juan Máximo , Cerezo-Hidalgo Clara , Márquez-Peláez Sergio 
Published: August 2022

Introduction The first Global Health Sector Strategy on viral hepatitis 2016-2021 provided the initial roadmap for the elimination of viral hepatitis as a public health problem by 2030. With the development of new therapeutic strategies that allow the elimination of the virus, the hypothesis is raised that population-based screening could increase the cases diagnosed in the initial stages of the disease, contributing to early treatment of infected people, avoiding the progression of chronic liver disease and its transmission. Objective To assess the safety, clinical effectiveness, and efficacy of mass screening for hepatitis C virus infection in reduction of mortality and/or morbidity. Methods A systematic literature search was performed in the following reference databases [2013-September 2020]: Medline, PreMedLine, EMBASE, Web of Science, and Cochrane Library. Additionally, a search with free terms was carried out on the International Network of Technology Assessment Agencies (INAHTA), as well as on websites of agencies not included in INAHTA and of national and international institutions. Two researchers independently performed the selection, critical appraisal, data extraction and risk of bias assessment of the included studies, resolving the discrepancies by discussion and consensus. Results We included 3 systematic reviews and 1 primary study subsequent to the search dates of the systematic reviews were included. Systematic reviews did not retrieve original studies evaluating the clinical effectiveness of population screening for hepatitis C versus no screening and other screening strategies. The primary study concluded that the cure rate of the disease was higher among screened people compared to a retrospective cohort, without providing data on the effects of screening on mortality or prevalence of infection. Adverse effects were limited to a retrospective case series review examining at physical harm, anxiety related to receiving a positive result, false-positive results, screening time, and stigma. Regarding the review of economic aspects, the data from the 16 evaluations included indicate taking into account the associated limitations in terms of the values of the prevalence parameters that they present, that the screening of higher-risk subgroups is the most efficient strategy, while the population-based screening followed by treatment can also be considered efficient compared to not screening in the medium and long term, with cost-effectiveness ratios below the usual decision threshold values. Conclusions The localized evidence does not demonstrate the clinical effectiveness of population-based screening for hepatitis C in reducing mortality, morbidity and/or its influence on quality of life. Not enough studies were identified to assess the safety of the population screening strategy. The compiled economic analyzes, bearing in mind the methodological limitations they present, show that the screening of the highest-risk subgroups would be the most efficient strategy. While population screening followed by treatment could be an efficient medium and long-term strategy to achieve the goal of eliminating viral hepatitis, it requires significant financial investment in health systems.