Cost-effective evaluation of acute viral hepatitis

Abstract

The performance of extensive serologic testing of patients who present to a primary care physician or to a hospital emergency department with possible acute viral hepatitis is not cost-effective (table). A selective serologic investigation is the most prudent approach to the diagnostic workup of this disease. We review two cases of patients with possible acute viral hepatitis to demonstrate the extra cost resulting from extensive serologic testing. In the following discussion, we review the epidemiologic features, demographics, and risk factors for the disease. We also propose a schematic, cost-effective approach to investigate whether acute viral hepatitis is present. The recommendations in this article were formulated after reviewing epidemiologic data from the Centers for Disease Control and Prevention.1 A MEDLINE search was also conducted, and recent articles on this topic were reviewed. REPORT OF CASES Patient 1A 19-year-old man had progressive anorexia and malaise, preceded by fever, for 1 week. Jaundice developed 1 day before he was seen by his physician. These symptoms developed eight days after he returned from a trip to Mexico. He denied injection drug use and was not sexually active. He was not taking any medications.A complete laboratory evaluation revealed the following liver function test results: alanine aminotransferase, 1,200 U/L; aspartate aminotransferase, 900 U/L; total bilirubin, 77 µmol/L (4.5 mg/dL); albumin, 43 g/L (4.3 g/dL); and international normalized ratio, 1.1. Hepatitis B virus (HBV) and hepatitis C virus (HCV) serologic test results were negative for hepatitis B surface antigen (HBsAg); hepatitis B e antigen (HBeAg); and antibodies to hepatitis B core antigen of immunoglobulin M type (anti-HBc IgM), hepatitis B e antigen (anti-HBe), hepatitis B surface antigen (anti-HBs), and HCV (anti-HCV). A finding of total and IgM antibodies to hepatitis A virus (anti-HAV) confirmed the diagnosis of acute hepatitis A.

Application of hepatitis serology testing algorithms to assess inappropriate laboratory utilization

“…Although it is commonly recommended to use algorithms for diagnosis of viral hepatitis (Ahmed & Keeffe 2000; Bendinelli et al . 2000; Sacher et al .…”

“…Hepatitis serology is a suitable test group for application of diagnostic algorithms, as the combination of test results makes it possible to determine the causative viral agent and the stage of the infection (van Walraven & Goel 2002). Many reflex algorithms guiding to adding or cancelling of one test depending on the result of another (Wu 1998) have been established for hepatitis serology (Ahmed & Keeffe 2000; Bendinelli et al . 2000; Sacher et al .…”

Inappropriate Use of Serological Tests for Hepatitis B Virus in Evliya Celebi Education and Research Hospital of Dumlupinar University, Kutahya

“…Laboratuvar harcamaları arasında, serolojik testlere yapılan ödemeler oldukça yüksek düzeylerdedir 5,6 . HBV enfeksiyonunda kullanılan testler için oldukça fazla miktarda para, iş gücü ve zaman harcanmaktadır.…”

Effects of Risk Factors on Anti-HBs Development in Hepatitis B Vaccinated and Nonvaccinated Populations

“…Antibody to hepatitis B core antigen (anti-HBc) develops in response to natural HBV infection that has no protection ability but appears as early as 6 weeks after infection and has lifelong persistence (3,4). In contrast, protective antibody to hepatitis B surface antigen (anti-HBs) is supposed to develop during convalescence after acute HBV infection as well as after hepatitis B vaccination but not in chronic infection (2).…”