If fully implemented, birth-cohort screening in primary
care would identify 808 580 new cases (85.9% of all
undiagnosed cases in the birth cohort, compared with
21.0% under risk-based screening) at a screening cost of
$2874 per new infection identified. This cost is similar to
other estimated costs per new diagnosis of hepatitis B or C
(30, 38). Birth-cohort screening is more costly than screening
based on injection-drug use or elevated alanine aminotransferase
levels, but those strategies probably miss many
infected patients. The Centers for Disease Control and
Prevention estimates that screening predicated on elevated
alanine aminotransferase levels would identify less than half
of the patients identified via birth-cohort screening (64).
Furthermore, testing based on alanine aminotransferase elevations
is already recommended in the Centers for Disease
Control and Prevention’s 1998 recommendations, but
many persons with chronic HCV infection remain undiagnosed
(12).