Is liver biopsy necessary prior to treatment of HCV

Is liver biopsy necessary prior to treatment of hepatitis C?: economic and medical implications.

Presented by: Howard P. Monsour, Jr., MD Affiliation: University of Texas Houston Health Science Center, Houston, TX

Should all persons who are infected with hepatitis C virus (HCV) have a liver biopsy done to determine whether they should be treated? Or is it more cost-effective to simply treat everyone with confirmed HCV? This controversy arises because recent evidence suggests that all patients who have HCV should be treated.

In this study, liver biopsy in most cases did not provide additional clinical information that couldn't have been obtained by physical examination, ultrasound or lab tests. Almost half of the patients with non-active hepatitis would have been treated anyway because of symptoms of their HCV. The cost of conducting liver biopsies in these 50 patients was $29,970 but the cost of treating the 11 patients with non-active hepatitis would have been $26,887; treating without a liver biopsy would result in an overall cost savings of $3,084 (10%).

These data suggest that there is no compelling reason to perform a routine liver biopsy in HCV-positive patients, but that the management course can usually be based on physical exam and other routine tests.