HSR&D Citation Abstract
Search | Search by Center | Search by Source | Keywords in Title
Utilization of surveillance for hepatocellular carcinoma among hepatitis C virus-infected veterans in the United States.
Davila JA, Henderson L, Kramer JR, Kanwal F, Richardson PA, Duan Z, El-Serag HB. Utilization of surveillance for hepatocellular carcinoma among hepatitis C virus-infected veterans in the United States. Annals of internal medicine. 2011 Jan 18; 154(2):85-93.
Surveillance for hepatocellular carcinoma (HCC) is recommended for patients with hepatitis C virus (HCV) infection and cirrhosis. However, whether surveillance is being done as recommended is unknown.
To examine the prevalence and determinants of HCC surveillance among HCV-infected patients with cirrhosis in Veterans Affairs (VA) health care facilities in the United States.
Retrospective cohort study of HCV-infected patients using data obtained from the national VA Hepatitis C Clinical Case Registry.
128 VA medical centers.
HCV-infected patients with cirrhosis diagnosed between fiscal years 1998 and 2005.
Abdominal ultrasonography and measurement of -fetoprotein for HCC surveillance were identified from administrative data by using a previously validated algorithm. Patients were categorized as having routine (tests done during at least 2 consecutive years in the 4 years after cirrhosis diagnosis), inconsistent (at least 1 test, but not routine), or no surveillance in the 4 years after cirrhosis diagnosis. Predictors of surveillance were identified by using hierarchical random-effects regression.
126 670 patients with HCV were identified; 13 002 (10.1%) had cirrhosis. Approximately 42.0% of patients with cirrhosis received 1 or more HCC surveillance tests within the first year after the cirrhosis index date; however, a decline in receipt of surveillance was observed in the following 2 to 4 years. Among patients with cirrhosis and at least 2 years of follow-up, routine surveillance occurred in 12.0%, inconsistent surveillance in 58.5%, and no surveillance in 29.5%. Lower medical and psychological comorbid conditions, presence of varices, and the absence of decompensated liver disease were associated with a higher likelihood of receiving routine surveillance.
Hepatocellular carcinoma surveillance tests were indirectly identified from registry data. Physician recommendations could not be captured.
Few HCV-infected veterans with cirrhosis received routine HCC surveillance. New strategies are needed to improve the implementation of HCC surveillance in clinical practice.
PRIMARY FUNDING SOURCE:
Houston Veterans Affairs Health Services Research and Development Center of Excellence and the National Cancer Institute.