Is widespread screening for hepatitis C justified?

Koretz and colleagues raise several important issues on the strength of the evidence base for HCV case finding through widespread screening, HCV treatment and liver disease prevention[1].

We disagree, however, with their solution of mounting a large scale trial of screening. Such a trial would be expensive, take many years and may still fail to reduce uncertainty about the natural history of HCV, when some of these uncertainties, e.g. liver disease progression after HCV treatment and non-liver disease mortality rates are taken into account in cost-effectiveness models of HCV treatment[2,3], which Koretz and colleagues perfunctorily dismiss.