Abstracto

Screening and diagnosis of chronic HCV infection in Bulgaria: A review of the current practice

Maria Dimitrova, Maria Kamusheva, Konstantin Mitov, Daniela Grekova, Guenka Petrova

Background: Chronic HCV infection is one of the leading causes of chronic liver disease and places significant health and economic burden worldwide. In Bulgaria blood and blood products weren`t screened before 1992. Currently there is no official national screening program and diagnosis is usually accidental and in more advanced stages of the disease.

Methods and Materials: A synthetic, population-based decision tree with Markov chain model compares the current practice (No screening) with possible screening program among (Screening) the people aged 39-64 as a part of the routine prophylaxis program. A Markov chain model was built at the end every decision node of the patients without Sustained Viral Response (SVR) to find how they will progress for the observed period.

Results: Possible national screening would lead to almost 4 times higher number of patients diagnosed at early stages of the infection, almost 2 to 4 times higher number of patients with access to treatment and decrease in the HCV-related expected mortality. Expected life years gained in the Screening alternative are almost 2 (10 417 LYGs) and 4 times (22 715 LYGs) higher compared to the current situation (4798 LYGs), respectively. Only 45% of the people however perform routine prophylaxis.

Conclusion: National screening is considered as effective health care measure to fight chronic diseases because through active search we can find asymptomatic patients. Initiation of treatment in early stages of hepatitis C infection is more effective and decreases the mortality rates.