Since 2010 our hospital has aimed to test all new patients diagnosed with tuberculosis (TB) or latent TB for hepatitis B and C. Guidelines from the NICE recommend all new patients with TB should be tested for HIV. However, no such guidelines exist regarding hepatitis B and C screening. We feel patients with undiagnosed hepatitis B and C should be identified prior to commencing anti-TB medication due to the potential risk of severe hepatotoxicity. Recently within London, anecdotally two patients with undiagnosed hepatitis treated for TB, subsequently required liver transplantation as a result of significant hepatotoxicity. A retrospective study was conducted to assess hepatitis B and C incidence within patients treated for TB and latent TB during 2012. Blood results were reviewed for any new hepatitis B/C results. Table 1 shows these results, highlighting that 4.7% of patients screened in both cohorts tested positive for Hepatitis B or C.
The two additional hospitals within the trust contribute a large number of additional TB and latent TB patients, totalling 1115 patients. Through extending the earlier observation of 4.7% Hepatitis B or C incidence in our hospital, there would be an estimated 51 patients affected across the trust.
Based on the individual costs of screening tests for Hepatitis B (£6.30) and C (£5.13), for the 1115 current TB patients, our trust wide hepatitis screening costs were estimated at £12,744. The approximate cost of a liver transplant operation at Kings College Hospital in 2012 was £125,000, not including the additional after care costs and accounting for possible complications. We feel the cost of hepatitis screening is outweighed by the benefits of identifying patients with positive serology in a timely fashion; permitting closer monitoring of their liver function and initiating an early gastroenterology referral.
It is vital we attempt to reduce the morbidity and possible mortality of hepatotoxicity in hepatitis positive TB patients; the financial, emotional and psychological implications for a patient undergoing a liver transplant are enormous. We propose that hepatitis screening is incorporated into current TB guidelines.
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