The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm

SummaryBackgroundThe prevalence of hepatitis C virus (HCV) infection in Egypt is the highest in the world, yet the total economic burden has not been quantified. Improved understanding of costs and the impact of treatment strategies will provide for better allocation of resources to reduce HCV disease and economic burden.AimA modelling approach was used to quantify the current HCV‐infected population, future disease progression and associated costs in Egypt.MethodsDirect healthcare costs were calculated from a nationally representative hospital and a disability adjusted life year (DALY) template was used with monetary value assigned to lost life years. Three scenarios were considered: (i) Historical treatment scenario: 50% SVR; 65 000 treated annually, (ii) Current treatment scenario: 90% sustained virologic response (SVR); 65 000 treated annually, (iii) Increased treatment scenario: 90% SVR; 325 000 treated annually by 2018.ResultsCumulative DALYs (2015–2030) under Scenario 1 were estimated at 7.88 million and cumulative costs estimated at $89.07 billion. Annual DALYs increased 16% during 2015–2030 while annual costs more than doubled. Scenario 2 reduced cumulative DALYs and costs by 7% and 4%, respectively. Under Scenario 3, total costs declined 73% to $1047 million during 2015–2030. As compared to Scenario 1, cumulative DALYs and costs decreased 37% and 35%, respectively.ConclusionsThis is the first estimate of the total economic burden of HCV in Egypt. Extraordinary measures are necessary to substantially reduce HCV disease and cost burden. With newer therapies, strategies to reduce disease burden are feasible and cost‐effective.

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“…Previous analysis estimated approximately 65 000 HCV patients were treated with pegylated interferon in 2014 6, 19…”

Section: Methodsmentioning

confidence: 99%

Economic burden of hepatitis C in Egypt: the future impact of highly effective therapies

Estes

Abdel-Kareem²,

Abdel-Razek³

et al. 2015

Aliment Pharmacol Ther

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“…The BEAST skyline output for each data set was superimposed on data derived from the epidemiological model estimates derived using the previously published system dynamic modeling framework [20,21]. Comparison of the trends reveals considerable similarities with regard to the timing of the exponential increases in the effective population size with the Bayesian phylogenetic analysis and the size of the HCV-infected population from epidemiological back-projections for both genotypes and continents (Figure 1).…”

Section: Comparison Of Coalescent Projections With Epidemiological Momentioning

confidence: 99%

“…Beta-PERT distributions were used to model uncertainty associated with all inputs. The model was simulated using a Monte-Carlo approach to determine the 95% uncertainty interval for prevalence [20,21]. The epidemiological estimates of HCV infection prevalence by age and sex [22][23][24] for the United States were extracted from the National Health and Nutrition Examination Survey, the US Centers for Disease Control and Prevention surveillance data between 1997 and 2007, and the number of patients with HCV infection cured antiviral therapy reported by publications between 1997 and 2007 [20].…”

Section: Epidemiological Modelmentioning

confidence: 99%

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Historical Trends in the Hepatitis C Virus Epidemics in North America and Australia

Rodrigo¹,

Eltahla²,

Bull³

et al. 2016

J Infect Dis.

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Background. Bayesian evolutionary analysis (coalescent analysis) based on genetic sequences has been used to describe the origins and spread of rapidly mutating RNA viruses, such as influenza, Ebola, human immunodeficiency virus (HIV), and hepatitis C virus (HCV).Methods. Full-length subtype 1a and 3a sequences from early HCV infections from the International Collaborative of Incident HIV and Hepatitis C in Injecting Cohorts (InC3), as well as from public databases from a time window of 1977-2012, were used in a coalescent analysis with BEAST software to estimate the origin and progression of the HCV epidemics in Australia and North America. Convergent temporal trends were sought via independent epidemiological modeling.Results. The epidemic of subtype 3a had more recent origins (around 1950) than subtype 1a (around 1920) in both continents. In both modeling approaches and in both continents, the epidemics underwent exponential growth between 1955 and 1975, which then stabilized in the late 20th century.Conclusions. Historical events that fuelled the emergence and spread of injecting drug use, such as the advent of intravenous medical therapies and devices, and growth in the heroin trade, as well as population mixing during armed conflicts, were likely drivers for the cross-continental spread of the HCV epidemics.

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“…A 16 országra kiterjedő elemzés alapján az prognosztizálható, hogy Magyarországon akkor várható a fertőzöttek számának csökkenése (részben a sikeres kezelés, részben a halálozás eredményeként) az elkövetkező években, ha a fertőzött egyének felismerését szervezett szűrőprogram segíti. Ebben az esetben 2025 után számíthatunk a HCV miatti májcirrhosis, dekom-penzált májcirrhosis, HCC és mortalitás, valamint az ezekkel kapcsolatos egészségügyi ráfordítás csökkenésére [9].…”

Section: A Hcv-fertőzés Epidemiológiája a Fertőzéshez Kapcsolódó Betunclassified

A hepatitis C-vírus-fertőzés és kezelésének költségvonzata

Makara

Hunyady

2015

Orvosi Hetilap

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A hepatitis C-vírus-fertőzés a Föld lakosságának 2-3%-át érinti és a betegséghez társuló egyéni következmények mellett igen jelentős össztársadalmi gazdasági problémát jelent. A kiadások elsősorban a nagyszámú fel nem ismert vagy előrehaladott stádiumban felismert betegnél kialakuló májcirrhosis szövődményeihez, a hepaticus encephalopathia, az ascites, a varixvérzés és a hepatocellularis carcinoma ellátásához, valamint a májátültetéshez kapcsolódnak. Nem elhanyagolhatók ugyanakkor a munkában töltött minőségi életévek számának csökkenése miatti veszteségek, valamint a fertőzés kezelésének költségei sem. Utóbbiak az új, interferonmentes terápiák megjelenésével némiképp megemelkedtek a korábbi, proteázgátlóval együtt vagy a nélkül alkalmazott pegilált interferon plusz ribavirin terápiákhoz képest, ugyanakkor komoly megtakarítást jelenthet, hogy lényegesen kevesebb mellékhatással és ehhez kapcsolódó költséggel kell számolni. A témakörben megjelent közlemények szerint a fertőzöttek szűrőprogramokkal történő megtalálása és hatékony készítményekkel történő kezelése rövid távon jelentős többletforrást igényel, de -túl azon, hogy a legtöbbször iatrogén úton okozott betegség meggyógyítása morális társadalmi kötelesség -hosszú távon egyértelműen megtakarítást eredményez. Orv. Hetil., 2015, 156(21), 862-868. Kulcsszavak: antivirális kezelés, direkt ható antivirális szerek, hepatitis C-vírus, interferon, költséghatékonyság Financial burden of hepatitis C infection and its treatmentThe worldwide prevalence of hepatitis C infection is 2-3%. In addition to its individual consequences, it generates huge fi nancial impact on national level. In particular, lack of recognition or late diagnosis of the disease is associated with high rate of liver cirrhosis related complications (hepatic encephalopathy, ascites, variceal bleeding, hepatocellular carcinoma) and/or demands liver transplantation. Loss of quality assisted life years and/or those spent in employment, reduced work productivity, as well as costs of antiviral therapy also contribute to the fi nancial burden. The costs of new interferon-free therapies may exceed the prices of previous pegylated interferon based therapies with or without protease inhibitors; however, shorter treatment durations and extremely low rates of severe side-effects with much less related expenses can reduce total costs of these treatments. In addition to the moral obligations, published cost-effectiveness analyses conclude that early diagnosis and treatment of this primarily iatrogenic infection through organized screening programs and wide access to effective therapies may lead to long term fi nancial benefi t. Rövidítések ABT3D = ombitasvir/paritaprevir/ritonavir+dasabuvir; ASV = asunaprevir; CHC = krónikus C-vírus hepatitis; DCV = daclatasvir; F0-F4 = májfi brosis-stádiumok; G1-G7 = hepatitis C-vírus genotípusok; HCC = hepatocellularis carcinoma; HCV = hepatitis C-vírus; ICER = (incremental cost-effectiveness ratio) növekményi költséghatékonysági arány; IFN = interferon; LDV = ledipasvir; peg-IFN ...

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The present and future disease burden of hepatitis C virus (HCV) infection with today's treatment paradigm

Cited by 406 publications

References 65 publications

Economic burden of hepatitis C in Egypt: the future impact of highly effective therapies

Economic burden of hepatitis C in Egypt: the future impact of highly effective therapies

Historical Trends in the Hepatitis C Virus Epidemics in North America and Australia

A hepatitis C-vírus-fertőzés és kezelésének költségvonzata

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