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Liver biopsy remains the standard, recommended method for assessing liver damage associated with chronic hepatitis C (HCV) infection. However, there is considerable debate about how liver biopsy should best be used, especially with the advent of more efficacious antiviral therapies. Dr Erik Groess and colleagues from California, USA identified the factors that influence the use of liver biopsy for HCV patients. In addition, the team described variations in liver biopsy use at the delivery system and patient level in a national VA sample.  | | Rates of liver biopsy ranged from 5% to 18% | | Journal of Hepatology |
The researchers analyzed VA HCV registry data for 171,893 VA patients with confirmed chronic HCV. Delivery system characteristics included geographic region and specialist time. Patient characteristics included antiviral treatment indicators, contraindications, volume of healthcare visits, and demographic variables. Logistic regression was used to explore correlates of biopsy use. Liver biopsy use in the VA system increased from 1997 to 2003 but began declining in 2004. The team noted that rates of liver biopsy from 2004 to 2006 varied by VA region, ranging from 5% to 18%. Treatment contraindications and laboratory tests were significantly associated with more biopsies. The researchers found that demographic variables were associated with fewer biopsies. Regional variability remained significant independent of volume of care and specialist time. Dr Groess' team commented, "Liver biopsy rates in the VA system have variability that seems unrelated to clinical need." "New antiviral therapies and non-invasive assessment techniques may create additional uncertainty for the role of liver biopsy, perhaps explaining its decline in recent years." "The availability of more effective antiviral therapies may also affect biopsy rates in the future."
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