With that said, this is comparable to other well-established screening initiatives that exist in the United States, such as cervical cancer or cholesterol screening. The limitations of this study are mostly intrinsic to its design. Because it is a model simulation, assumptions have to be made. These assumptions may be close NVP-LDE225 solubility dmso to, or veer far from, reality. For example, the probability of sustained virological response

(SVR) with DAAs plus standard of care was estimated based on results of one clinical trial (ADVANCE).7 This trial used telaprevir, one of the two approved PIs, and led, among previously naïve patients, to the highest SVR rate of 75%. This percentage was multiplied by the ratio of the average SVR rate of Peg-IFN/RBV therapy (genotypes 1/4) in primary care setting divided by the Selleckchem AZD3965 SVR of Peg-IFN/RBV therapy observed in clinical trials (0.33:0.46). As we all know, the real-world response rates will undoubtedly be less than 75%, in part as the result of the higher proportion of patients with cirrhosis that will be treated, with cirrhosis being a clear negative predictive factor of response

with triple therapy. There is no final data yet, but early data from the European Association for the Study of Liver Disease suggest, in patients with cirrhosis at least, lower response rates and more side effects, potentially leading to a higher discontinuation rate.10, 11 The assumed probability of SVR of 54% in the present study may or may not represent the real-life setting. A study published by McGarry et al. in HEPATOLOGY this year showed similar results.12 Also, based on a Markov model of the natural history of HCV, the investigators assessed the potential costs and benefits of a birth-cohort screening program in the United States. In this model, screening 100% of U.S. residents born 1946-1970 over 5 years would avoid 78,000 HCV-related deaths, which is analogous to the data in the Rein et

al. study. Similarly, the ICER of birth-cohort screening with DAAs plus standard treatment was $37,700 per QALYs saved, compared with risk-based screening, which is similar to the findings of Rein et al. As the anniversary of the approval of DAAs approaches, the CDC has proposed “an expansion of its current learn more risk-based guidelines to include a simple, one-time blood test for all baby boomers.”1 The cost-effectiveness analysis presented supports these recommendations. The investigators were wise to point out that these numbers are based on the published clinical trial data, which may overestimate the cure rates. On the other hand, at the pace at which HCV drug development is moving with the expected approval of two to four new DAAs in 2014 and many more after that, these lower real response rates may be a thing of the past.