The Changing Burden of Hepatitis C Virus Infection in the United States: Model-Based Predictions

Abstract

Background Chronic hepatitis C virus (HCV) infection causes substantial health and economic burden in the United States (US). With the availability of direct-acting antiviral agents (DAAs), recently approved and other therapies under development and 1-time birth-cohort screening, the burden of HCV disease is expected to decrease. Objective To predict the impact of new therapies and screening on chronic HCV cases and associated disease outcomes. Design Individual-level state-transition model. Setting Existing and anticipated HCV therapies and screening in the US. Patients Total HCV-infected population in the US. Measurements Chronic HCV cases and advanced-stage HCV outcomes. Results The number of chronic HCV cases decreased from 3.2 million in 2001 to 2.3 million in 2013. One-time birth-cohort screening beginning in 2013 is expected to identify 487 000 HCV cases in the next 10 years. In contrast, 1-time universal screening could identify 933 700 HCV cases. With the availability of highly effective therapies, HCV could become a rare disease in the next 22 years. The adoption of recently approved HCV therapies and one-time birth-cohort screening can prevent approximately 124 200 cases of decompensated cirrhosis, 78 800 cases of hepatocellular carcinoma, 126 500 liver-related deaths and 9900 liver transplants by 2050. Increasing the treatment capacity would further reduce the burden of HCV-related disease. Limitations Empirical data on the effectiveness of the future HCV therapies, on the future annual incidence of HCV, and on HCV treatment capacity are lacking. Conclusions New HCV therapies along with widespread implementation of screening and treatment will play an important role in reducing the burden of HCV disease. More aggressive screening recommendations are needed to identify a large pool of infected patients. Funding source National Institutes of Health.

Broad Hepatitis C Treatment Scenarios Return Substantial Health Gains, But Capacity Is A Concern

“…Therefore, the fourth scenario is "treat 5 percent," in which 5 percent of patients who are infected with a score of F0 or higher are treated with new agents. [31][32][33] In this scenario, 125,000 patients are treated in the first year.…”

Survival and cost‐effectiveness of sorafenib therapy in advanced hepatocellular carcinoma: An analysis of the SEER–Medicare database

“…The population of patients with HCC is shifting to a more elderly demographic, largely due to an aging population with chronic hepatitis C virus infection; thus, the impact of age and accumulated comorbidities is becoming increasingly relevant when making HCC treatment decisions. (6) To address the gaps in the existing literature, we analyzed the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database to determine the survival benefit and cost-effectiveness associated with sorafenib treatment for advanced HCC in clinical practice.…”

Epidemiological Trends of Hepatocellular Carcinoma in Austria

“…The launch of these new agents might further reduce the burden of HCV and consequently decrease HCC incidence. Indeed, model-based predictions suggest that recently approved direct-acting agents for HCV infection and one-time birth screening for HCV could prevent 78,800 cases of HCC in the United States by 2050 [26]. Regarding HBV, the implementation of infant vaccination has already decreased the number of HBV-related HCC in endemic areas [5,27].…”

“…The latest advances in HCV treatment with the development of more potent agents allowing all-oral as well as interferon-free regimens have shown potential to increase response rates, decrease treatment duration and improve tolerability [26]. The launch of these new agents might further reduce the burden of HCV and consequently decrease HCC incidence.…”

“…Extrahepatic metastases were rarely diagnosed and associated with dismal survival. The burden of viral hepatitis is expected to decrease in the upcoming decades [5,26]. Nevertheless, HCC incidence is supposed to remain high due to the high level of alcoholic liver disease and the predicted increase in the incidence of NAFLD resulting from obesity and diabetes mellitus [17].…”