Screening for Hepatitis C Virus Infection in Adults: Comparative Effectiveness Review Number 69
Screening for Hepatitis C Virus Infection in Adults: Comparative Effectiveness Review Number 69
Overview
Hepatitis C virus (HCV) is a single-stranded, positive-sense RNA virus of the family Flaviviridae. HCV is the most common chronic bloodborne pathogen in the U.S. The prevalence of anti-HCV antibody in the U.S. is estimated at 1.6 %. Approximately 78 % of those who test positive for anti-HCV antibody have the HCV detectable in the blood (viremia), indicating chronic infection; those with anti-HCV antibody but no viremia are considered to have cleared the infection. The prevalence of chronic HCV infection is thought to have peaked in 2001 at 3.6 million people. The yearly incidence of HCV infection averaged more than 200,000 cases per year in the 1980s, but by 2001 had declined to around 25,000 cases per year. The Centers for Disease Control and Prevention (CDC) estimated 16,000 new cases of HCV infection in 2009. HCV infection is a leading cause of complications from chronic liver disease and was associated with an estimated 15,000 deaths in the U.S. in 2007. One study estimated that the total number of patients with cirrhosis will peak at 1.0 million in 2020, though rates of hepatic decompensation and liver cancer are expected to continue to rise for another 10 to 13 years given the long lag time between infection and development of cirrhosis and other complications. Screening for HCV infection in asymptomatic adults who have no history of liver disease or known liver enzyme abnormalities may identify infected patients at earlier stages of disease, before they develop serious or irreversible liver damage. A high proportion of people with chronic HCV infection are thought to be unaware of their status. The purpose of this report is to review the evidence screening for chronic HCV infection in asymptomatic adults without known liver enzyme abnormalities. The Agency for Healthcare Research and Quality, which commissioned this review, also commissioned a separate but complementary review on effectiveness of antiviral treatments. These reviews will be used by the USPSTF to update its recommendations on HCV screening. This review focuses on research gaps identified in the 2004 USPSTF review and new studies published since that review. The following Key Questions are the focus of our report: Key Question 1: a. Does screening for HCV infection in nonpregnant adults without known abnormal liver enzymes reduce mortality and morbidity due to HCV infection, affect quality of life, or reduce incidence of HCV infection? b. Does screening for HCV infection during pregnancy reduce vertical transmission of HCV or improve mortality or morbidity for the mother or child? Key Question 2: a. What is the effectiveness of different risk- or prevalence-based methods for screening for HCV infection on clinical outcomes? b. What is the sensitivity and number needed to screen to identify one case of HCV infection of different risk- or prevalence-based methods for screening for HCV infection? Key Question 3: What are the harms associated with screening for HCV infection, including adverse effects such as anxiety, labeling, and impact on relationships? Key Question 4: a. What is the comparative effectiveness and comparative diagnostic accuracy of various tests and strategies for the workup to guide treatment decisions in patients who are HCV positive? b. What proportion of patients with screen-detected HCV infection receives treatment? Key Question 5: What are the harms associated with the workup for guiding treatment decisions? Key Question 6: a. How effective is counseling or immunizations of patients with HCV infection at improving health outcomes or reducing the spread of HCV? b. Does becoming aware of positive HCV infection status decrease high-risk behaviors? c. How effective is counseling or immunization of patients with HCV infection at improving intermediate outcomes, including change in high-risk behaviors? Key Question 7: Do any interventions decrease or increase the vertical transmission of HCV during delivery or in the perinatal period?Description
Condition Guidelines
Books - New and Used
The following guidelines apply to books:
- New: A brand-new copy with cover and original protective wrapping intact. Books with markings of any kind on the cover or pages, books marked as "Bargain" or "Remainder," or with any other labels attached, may not be listed as New condition.
- Used - Good: All pages and cover are intact (including the dust cover, if applicable). Spine may show signs of wear. Pages may include limited notes and highlighting. May include "From the library of" labels. Shrink wrap, dust covers, or boxed set case may be missing. Item may be missing bundled media.
- Used - Acceptable: All pages and the cover are intact, but shrink wrap, dust covers, or boxed set case may be missing. Pages may include limited notes, highlighting, or minor water damage but the text is readable. Item may but the dust cover may be missing. Pages may include limited notes and highlighting, but the text cannot be obscured or unreadable.
Note: Some electronic material access codes are valid only for one user. For this reason, used books, including books listed in the Used – Like New condition, may not come with functional electronic material access codes.
Shipping & Delivery
Shipping Fees
- Stevens Books offers FREE SHIPPING everywhere in the United States for ALL non-book orders, and $3.99 for each book.
- Packages are shipped from Monday to Friday.
- No additional fees and charges.
Delivery Times
The usual time for processing an order is 24 hours (1 business day), but may vary depending on the availability of products ordered. This period excludes delivery times, which depend on your geographic location.
Estimated delivery times:
- Standard Shipping: 5-8 business days
- Expedited Shipping: 3-5 business days
Shipping method varies depending on what is being shipped.
Tracking
All orders are shipped with a tracking number. Once your order has left our warehouse, a confirmation e-mail with a tracking number will be sent to you. You will be able to track your package at all times.
Damaged Parcel
If your package has been delivered in a PO Box, please note that we are not responsible for any damage that may result (consequences of extreme temperatures, theft, etc.).
If you have any questions regarding shipping or want to know about the status of an order, please contact us or email to support@stevensbooks.com.
Returns & Refunds
You may return most items within 30 days of delivery for a full refund.
To be eligible for a return, your item must be unused and in the same condition that you received it. It must also be in the original packaging.
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. We also do not accept products that are intimate or sanitary goods, hazardous materials, or flammable liquids or gases.
Additional non-returnable items:
- Gift cards
- Downloadable software products
- Some health and personal care items
To complete your return, we require a tracking number, which shows the items which you already returned to us.
There are certain situations where only partial refunds are granted (if applicable)
- Book with obvious signs of use
- CD, DVD, VHS tape, software, video game, cassette tape, or vinyl record that has been opened
- Any item not in its original condition, is damaged or missing parts for reasons not due to our error
- Any item that is returned more than 30 days after delivery
Items returned to us as a result of our error will receive a full refund,some returns may be subject to a restocking fee of 7% of the total item price, please contact a customer care team member to see if your return is subject. Returns that arrived on time and were as described are subject to a restocking fee.
Items returned to us that were not the result of our error, including items returned to us due to an invalid or incomplete address, will be refunded the original item price less our standard restocking fees.
If the item is returned to us for any of the following reasons, a 15% restocking fee will be applied to your refund total and you will be asked to pay for return shipping:
- Item(s) no longer needed or wanted.
- Item(s) returned to us due to an invalid or incomplete address.
- Item(s) returned to us that were not a result of our error.
You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days).
If you need to return an item, please Contact Us with your order number and details about the product you would like to return. We will respond quickly with instructions for how to return items from your order.
Shipping Cost
We'll pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.). In other cases, you will be responsible for paying for your own shipping costs for returning your item. Shipping costs are non-refundable. If you receive a refund, the cost of return shipping will be deducted from your refund.
Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
Overview
Hepatitis C virus (HCV) is a single-stranded, positive-sense RNA virus of the family Flaviviridae. HCV is the most common chronic bloodborne pathogen in the U.S. The prevalence of anti-HCV antibody in the U.S. is estimated at 1.6 %. Approximately 78 % of those who test positive for anti-HCV antibody have the HCV detectable in the blood (viremia), indicating chronic infection; those with anti-HCV antibody but no viremia are considered to have cleared the infection. The prevalence of chronic HCV infection is thought to have peaked in 2001 at 3.6 million people. The yearly incidence of HCV infection averaged more than 200,000 cases per year in the 1980s, but by 2001 had declined to around 25,000 cases per year. The Centers for Disease Control and Prevention (CDC) estimated 16,000 new cases of HCV infection in 2009. HCV infection is a leading cause of complications from chronic liver disease and was associated with an estimated 15,000 deaths in the U.S. in 2007. One study estimated that the total number of patients with cirrhosis will peak at 1.0 million in 2020, though rates of hepatic decompensation and liver cancer are expected to continue to rise for another 10 to 13 years given the long lag time between infection and development of cirrhosis and other complications. Screening for HCV infection in asymptomatic adults who have no history of liver disease or known liver enzyme abnormalities may identify infected patients at earlier stages of disease, before they develop serious or irreversible liver damage. A high proportion of people with chronic HCV infection are thought to be unaware of their status. The purpose of this report is to review the evidence screening for chronic HCV infection in asymptomatic adults without known liver enzyme abnormalities. The Agency for Healthcare Research and Quality, which commissioned this review, also commissioned a separate but complementary review on effectiveness of antiviral treatments. These reviews will be used by the USPSTF to update its recommendations on HCV screening. This review focuses on research gaps identified in the 2004 USPSTF review and new studies published since that review. The following Key Questions are the focus of our report: Key Question 1: a. Does screening for HCV infection in nonpregnant adults without known abnormal liver enzymes reduce mortality and morbidity due to HCV infection, affect quality of life, or reduce incidence of HCV infection? b. Does screening for HCV infection during pregnancy reduce vertical transmission of HCV or improve mortality or morbidity for the mother or child? Key Question 2: a. What is the effectiveness of different risk- or prevalence-based methods for screening for HCV infection on clinical outcomes? b. What is the sensitivity and number needed to screen to identify one case of HCV infection of different risk- or prevalence-based methods for screening for HCV infection? Key Question 3: What are the harms associated with screening for HCV infection, including adverse effects such as anxiety, labeling, and impact on relationships? Key Question 4: a. What is the comparative effectiveness and comparative diagnostic accuracy of various tests and strategies for the workup to guide treatment decisions in patients who are HCV positive? b. What proportion of patients with screen-detected HCV infection receives treatment? Key Question 5: What are the harms associated with the workup for guiding treatment decisions? Key Question 6: a. How effective is counseling or immunizations of patients with HCV infection at improving health outcomes or reducing the spread of HCV? b. Does becoming aware of positive HCV infection status decrease high-risk behaviors? c. How effective is counseling or immunization of patients with HCV infection at improving intermediate outcomes, including change in high-risk behaviors? Key Question 7: Do any interventions decrease or increase the vertical transmission of HCV during delivery or in the perinatal period?Description
Condition Guidelines
Books - New and Used
The following guidelines apply to books:
- New: A brand-new copy with cover and original protective wrapping intact. Books with markings of any kind on the cover or pages, books marked as "Bargain" or "Remainder," or with any other labels attached, may not be listed as New condition.
- Used - Good: All pages and cover are intact (including the dust cover, if applicable). Spine may show signs of wear. Pages may include limited notes and highlighting. May include "From the library of" labels. Shrink wrap, dust covers, or boxed set case may be missing. Item may be missing bundled media.
- Used - Acceptable: All pages and the cover are intact, but shrink wrap, dust covers, or boxed set case may be missing. Pages may include limited notes, highlighting, or minor water damage but the text is readable. Item may but the dust cover may be missing. Pages may include limited notes and highlighting, but the text cannot be obscured or unreadable.
Note: Some electronic material access codes are valid only for one user. For this reason, used books, including books listed in the Used – Like New condition, may not come with functional electronic material access codes.
Shipping & Delivery
Shipping Fees
- Stevens Books offers FREE SHIPPING everywhere in the United States for ALL non-book orders, and $3.99 for each book.
- Packages are shipped from Monday to Friday.
- No additional fees and charges.
Delivery Times
The usual time for processing an order is 24 hours (1 business day), but may vary depending on the availability of products ordered. This period excludes delivery times, which depend on your geographic location.
Estimated delivery times:
- Standard Shipping: 5-8 business days
- Expedited Shipping: 3-5 business days
Shipping method varies depending on what is being shipped.
Tracking
All orders are shipped with a tracking number. Once your order has left our warehouse, a confirmation e-mail with a tracking number will be sent to you. You will be able to track your package at all times.
Damaged Parcel
If your package has been delivered in a PO Box, please note that we are not responsible for any damage that may result (consequences of extreme temperatures, theft, etc.).
If you have any questions regarding shipping or want to know about the status of an order, please contact us or email to support@stevensbooks.com.
Returns & Refunds
You may return most items within 30 days of delivery for a full refund.
To be eligible for a return, your item must be unused and in the same condition that you received it. It must also be in the original packaging.
Several types of goods are exempt from being returned. Perishable goods such as food, flowers, newspapers or magazines cannot be returned. We also do not accept products that are intimate or sanitary goods, hazardous materials, or flammable liquids or gases.
Additional non-returnable items:
- Gift cards
- Downloadable software products
- Some health and personal care items
To complete your return, we require a tracking number, which shows the items which you already returned to us.
There are certain situations where only partial refunds are granted (if applicable)
- Book with obvious signs of use
- CD, DVD, VHS tape, software, video game, cassette tape, or vinyl record that has been opened
- Any item not in its original condition, is damaged or missing parts for reasons not due to our error
- Any item that is returned more than 30 days after delivery
Items returned to us as a result of our error will receive a full refund,some returns may be subject to a restocking fee of 7% of the total item price, please contact a customer care team member to see if your return is subject. Returns that arrived on time and were as described are subject to a restocking fee.
Items returned to us that were not the result of our error, including items returned to us due to an invalid or incomplete address, will be refunded the original item price less our standard restocking fees.
If the item is returned to us for any of the following reasons, a 15% restocking fee will be applied to your refund total and you will be asked to pay for return shipping:
- Item(s) no longer needed or wanted.
- Item(s) returned to us due to an invalid or incomplete address.
- Item(s) returned to us that were not a result of our error.
You should expect to receive your refund within four weeks of giving your package to the return shipper, however, in many cases you will receive a refund more quickly. This time period includes the transit time for us to receive your return from the shipper (5 to 10 business days), the time it takes us to process your return once we receive it (3 to 5 business days), and the time it takes your bank to process our refund request (5 to 10 business days).
If you need to return an item, please Contact Us with your order number and details about the product you would like to return. We will respond quickly with instructions for how to return items from your order.
Shipping Cost
We'll pay the return shipping costs if the return is a result of our error (you received an incorrect or defective item, etc.). In other cases, you will be responsible for paying for your own shipping costs for returning your item. Shipping costs are non-refundable. If you receive a refund, the cost of return shipping will be deducted from your refund.
Depending on where you live, the time it may take for your exchanged product to reach you, may vary.
If you are shipping an item over $75, you should consider using a trackable shipping service or purchasing shipping insurance. We don’t guarantee that we will receive your returned item.
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