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Modelling the impact of improving screening and treatment of chronic hepatitis C virus infection on future hepatocellular carcinoma rates and liver-related mortality

Modelling the impact of improving screening and treatment of chronic hepatitis C virus infection on future hepatocellular carcinoma rates and liver-related mortality
Modelling the impact of improving screening and treatment of chronic hepatitis C virus infection on future hepatocellular carcinoma rates and liver-related mortality
Background: The societal, clinical and economic burden imposed by the complications of chronic hepatitis C virus (HCV) infection - including cirrhosis and hepatocellular carcinoma (HCC) - is expected to increase over the coming decades. However, new therapies may improve sustained virological response (SVR) rates and shorten treatment duration. This study aimed to estimate the future burden of HCV-related disease in England if current management strategies remain the same and the impact of increasing diagnosis and treatment of HCV as new therapies become available.

Methods: A previously published model was adapted for England using published literature and government reports, and validated through an iterative process of three meetings of HCV experts. The impact of increasing diagnosis and treatment of HCV as new therapies become available was modelled and compared to the base-case scenario of continuing current management strategies. To assess the ‘best case’ clinical benefit of new therapies, the number of patients treated was increased by a total of 115% by 2018.

Results: In the base-case scenario, total viraemic (HCV RNA-positive) cases of HCV in England will decrease from 144,000 in 2013 to 76,300 in 2030. However, due to the slow progression of chronic HCV, the number of individuals with cirrhosis, decompensated cirrhosis and HCC will continue to increase over this period. The model suggests that the ‘best case’ substantially reduces HCV-related hepatic disease and HCV-related liver mortality by 2020 compared to the base-case scenario. The number of HCV-related HCC cases would decrease 50% by 2020 and the number progressing from infection to decompensated cirrhosis would decline by 65%. Therefore, compared to projections of current practices, increasing treatment numbers by 115% by 2018 would reduce HCV-related mortality by 50% by 2020.

Conclusions: This analysis suggests that with current treatment practices the number of patients developing HCV-related cirrhosis, decompensated cirrhosis and HCC will increase substantially, with HCV-related liver deaths likely to double by 2030. However, increasing diagnosis and treatment rates could optimise the reduction in the burden of disease produced by the new therapies, potentially halving HCV-related liver mortality and HCV-related HCC by 2020.
1-10
Cramp, Matthew E.
94034caa-fd63-48ef-bb7f-8f02f833bbce
Rosenberg, William M.
ac36bd93-2303-4a46-96f6-3daee7ec53b5
Ryder, Steven D.
ff0ec802-421b-4033-a960-da5fae9c7f45
Blach, Sarah
5b776e42-9530-4047-888a-03236a17d56a
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Cramp, Matthew E.
94034caa-fd63-48ef-bb7f-8f02f833bbce
Rosenberg, William M.
ac36bd93-2303-4a46-96f6-3daee7ec53b5
Ryder, Steven D.
ff0ec802-421b-4033-a960-da5fae9c7f45
Blach, Sarah
5b776e42-9530-4047-888a-03236a17d56a
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984

Cramp, Matthew E., Rosenberg, William M., Ryder, Steven D., Blach, Sarah and Parkes, Julie (2014) Modelling the impact of improving screening and treatment of chronic hepatitis C virus infection on future hepatocellular carcinoma rates and liver-related mortality. BMC Gastroenterology, 14 (137), 1-10. (doi:10.1186/1471-230X-14-137). (PMID:25100159)

Record type: Article

Abstract

Background: The societal, clinical and economic burden imposed by the complications of chronic hepatitis C virus (HCV) infection - including cirrhosis and hepatocellular carcinoma (HCC) - is expected to increase over the coming decades. However, new therapies may improve sustained virological response (SVR) rates and shorten treatment duration. This study aimed to estimate the future burden of HCV-related disease in England if current management strategies remain the same and the impact of increasing diagnosis and treatment of HCV as new therapies become available.

Methods: A previously published model was adapted for England using published literature and government reports, and validated through an iterative process of three meetings of HCV experts. The impact of increasing diagnosis and treatment of HCV as new therapies become available was modelled and compared to the base-case scenario of continuing current management strategies. To assess the ‘best case’ clinical benefit of new therapies, the number of patients treated was increased by a total of 115% by 2018.

Results: In the base-case scenario, total viraemic (HCV RNA-positive) cases of HCV in England will decrease from 144,000 in 2013 to 76,300 in 2030. However, due to the slow progression of chronic HCV, the number of individuals with cirrhosis, decompensated cirrhosis and HCC will continue to increase over this period. The model suggests that the ‘best case’ substantially reduces HCV-related hepatic disease and HCV-related liver mortality by 2020 compared to the base-case scenario. The number of HCV-related HCC cases would decrease 50% by 2020 and the number progressing from infection to decompensated cirrhosis would decline by 65%. Therefore, compared to projections of current practices, increasing treatment numbers by 115% by 2018 would reduce HCV-related mortality by 50% by 2020.

Conclusions: This analysis suggests that with current treatment practices the number of patients developing HCV-related cirrhosis, decompensated cirrhosis and HCC will increase substantially, with HCV-related liver deaths likely to double by 2030. However, increasing diagnosis and treatment rates could optimise the reduction in the burden of disease produced by the new therapies, potentially halving HCV-related liver mortality and HCV-related HCC by 2020.

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Accepted/In Press date: 17 July 2014
Published date: 7 August 2014
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 396571
URI: http://eprints.soton.ac.uk/id/eprint/396571
PURE UUID: 2dd0f54e-db54-4900-be12-54510302a2fc
ORCID for Julie Parkes: ORCID iD orcid.org/0000-0002-6490-395X

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Date deposited: 13 Jun 2016 11:03
Last modified: 18 Feb 2021 16:51

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Contributors

Author: Matthew E. Cramp
Author: William M. Rosenberg
Author: Steven D. Ryder
Author: Sarah Blach
Author: Julie Parkes ORCID iD

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