LAUSR

BACKGROUND AND AIM To assess utilization of health care services in people with decompensated cirrhosis (DC) or hepatocellular carcinoma (HCC) and a "late diagnosis" of hepatitis B or hepatitis C. METHODS Hepatitis B and C cases during 1997-2016 in Victoria, Australia were linked with hospitalizations, deaths, liver cancer diagnoses, and medical services. A late diagnosis was defined as hepatitis B or hepatitis C notification occurring after, at the same time, or within two years preceding an HCC/DC diagnosis. Services provided during the 10-year period prior to HCC/DC diagnosis were assessed, including general practitioner (GP) or specialist visits, emergency department (ED) presentations, hospital admissions, and blood tests. RESULTS Of the 25,766 notified cases of hepatitis B, 751 (2.9%) were diagnosed with HCC/DC, and hepatitis B was diagnosed late in 385 (51.3%). Of 44,317 cases of hepatitis C, 2,576 (5.8%) were diagnosed with HCC/DC and hepatitis C was diagnosed late in 857 (33.3%). Although late diagnosis dropped over time, missed opportunities for timely diagnosis were observed. Most people diagnosed late had visited a GP (97.4% for hepatitis B, 98.9% for hepatitis C) or had a blood test (90.9% for hepatitis B, 88.6% for hepatitis C) during the ten years prior to HCC/DC diagnosis. The median number of GP visits was 24 and 32, and blood tests 7 and 8, for hepatitis B and C respectively. CONCLUSIONS Late diagnosis of viral hepatitis remains a concern, with the majority having frequent health care service provision in the preceding period, indicating missed opportunities for diagnosis.