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Robert Anderson sent a note to John Canavan on the prospects for an economic analysis of screening blood donations for Hepatitis C which indicated that more data was required to assess the value of the benefits that could be achieved.

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The Economic Advisers' Office prepared an appraisal on the prospect of screening all blood donations for Hepatitis C and stated that alternative sources of data could contribute to assessment of its value.

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In a memo to Dr Metters and Elizabeth Baldock, John Canavan stated that at a meeting on 24 April their committee reaffirmed its view that the introduction of routine screening would not yet be justified.

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In an article in the associated press it stated that US Blood Banks were to begin immediately screening donated blood for Hepatitis C.

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Dr Pickles stated in a memo that the department considered that there was insufficient scientific information about the test and the matter of testing blood donations for hepatitis was being kept under review.

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In a memo to the Economic Advisers' Office, John Canavan requested an update on the cost/benefit analysis as experts now seemed to think that advances in knowledge about the anti-HCV tests and the means of confirming the results made it very difficult to resist the introduction of screening, and a number of countries had already done so.

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Dr Rejman wrote that there was a lack of good data but that the Ortho and Abbott ELISA tests were not very specific when used prospectively in screening donors. His view was that screening of blood donations for Hepatitis C appeared to be of benefit to recipients but could pose major problems to donors given falsely positive results.

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Dr Gunson wrote to Dr Metters suggesting that the next ACVSB meeting (which had been scheduled for October) should take place in mid November after the next Ortho Hepatitis C Symposium.

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Dr Metters expressed concern about the resource consequences if the ACVSB were to recommend introducing Hepatitis C screening for all blood donations.

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The minister was told of the ACVSB's recommendation by a minute, with the indication that a full submission would be provided shortly.

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Dr Metters stated that if the Ortho symposium produced any significant new information there would still be time to take it into account in preparation for testing in the NBTS.

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Dr Metters stated that Professor Zuckerman has said "at least 30% of such cases could be avoided, possibly more."

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Dr Mortimer wrote to Dr Rejman and raised concerns about who would do and fund the confirmatory RIBA and PCR tests required for the implementation of the screening programme, suggesting that "Failure to make adequate provision for confirmatory testing would seem to me to call the screening programme into question."

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There was concern about the funding implications of testing, even to the extent that a minute from Mark Fuller said that delay "can only help".

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Dr Gunson said: "I should say that, despite the concerns expressed (in particular by Dr Contreras at the North London RTC), this approach gave rise to no serious difficulties in practice, and I do not believe that it had any consequences for the implementation date eventually achieved."

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Dr Pickles wrote to John Canavan: "Dr Gunson has been in touch with all the RTCs about starting dates for HCV testing. There are all sorts of problems still, eg exact choice of test, supplies of this, confirmatory testing arrangements, training etc etc."

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Dr Gunson stated that he doubted "whether the Newcastle and Glasgow Centres have the laboratory capability to carry out the additional work now proposed."

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The minister was informed that it was unlikely that routine screening could be introduced before 1 April 1991. In fact, the date of introduction slipped from April to July to September.

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Dr Gunson informed the Department of Health: "the other major competitor company feels disadvantaged, and has also caused problems in Scotland."

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Dr Gunson included a briefing note in case of press inquiries, which stressed the importance of selecting tests with proven reliability.

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