PEOPLE BORN BETWEEN 1965 and 1985 in Ireland should be offered once-off testing for the Hepatitis C virus (HCV), the Health Information and Quality Authority (Hiqa) has recommended.

Hiqa has advised the Minister for Health that implementation of a testing programme for people born during this period would be cost-effective and help Ireland achieve its goal to eliminate HCV.

Following a public consultation, the Health Technology Assessment (HTA) of birth cohort testing for Hepatitis C was approved by the Board of Hiqa and has been submitted to Stephen Donnelly for his consideration.

The Journal has contacted the Department of Health for comment.

HCV primarily affects the liver. People can get the virus from the blood of someone who has Hepatitis C.

The virus can also cause other health problems such as constant fatigue and joint pains.

In Ireland, the prevalence of HCV infection is highest amongst those born between 1965 and 1985. Of the 1.5 million people in this cohort, it is estimated that one in every 100 may have chronic HCV infection.

Hiqa has concluded that offering testing to this group would represent good value for money but that due to the number of individuals involved, testing would have significant upfront costs.

The body has noted that an initial pilot programme would be beneficial to confirm the prevalence estimates and to address issues concerning the feasibility of the programme before rolling it out nationally.

Implementing a systematic birth cohort testing programme is estimated to cost €65 million over a five-year period. However, Hiqa has said subsequent costs would be “minimal” and the programme would ultimately be cost-saving as treatment for the complications of chronic HCV infection will be avoided.

Between 55 and 85 people out of every 100 ever infected with Hepatitis C will develop chronic HCV infection – this progresses slowly and can take decades for symptoms to show.

As reported earlier this year, the State has paid out over €1 billion in compensation to victims of contaminated blood products. A tribunal was established to compensate people infected with Hepatitis C as a result of being administered with contaminated blood between 1970 and 1994.

Ireland currently provides a risk-based approach to testing for HCV. Major risk factors include a history of injecting unprescribed or illicit drugs and needle-stick injuries.

The introduction of birth cohort testing would not impact access to existing risk-based approaches for detecting hepatitis C infection or the treatment of people identified through risk-based testing, Hiqa has noted.

Liver damage

Infection with HCV has been a notifiable disease in Ireland since 2004. From 2004 to 2018, a total of 15,266 HCV cases were notified to the Health Protection Surveillance Centre (HPSC).

Of these, 71% were among people born between 1965 and 1985. However, it is estimated that there are approximately 12,000 people with undiagnosed chronic HCV infection in this birth cohort.

Dr Máirín Ryan, Hiqa’s Deputy CEO and Director of Health Technology Assessment, today said: “Chronic HCV infection is frequently called the ‘silent disease’, as many people do not have symptoms and don’t realise that they are infected. However, the damage it does is not silent.

“If left untreated, chronic HCV infection can cause severe damage to the liver and other organs. For example, 128 liver transplants completed in Ireland between 2005 and 2018 were due to HCV.”

Dr Ryan continued: “From reviewing the evidence, we found that the tests available to diagnose chronic HCV infection are highly accurate. Furthermore, the treatments are safe and effective, with over 95% of people treated being cured of their infection.”

Countries globally are setting targets to eliminate viral hepatitis as a public health threat. In Ireland, the Health Service Executive aims to achieve the World Health Organization’s target of making Hepatitis C a rare disease before 2030.