Atif Zaman, MD, MPH
This scenario assumes use of onetime birth-cohort screening and next-generation treatment regimens, which would need to be widely available.
Implementation of newly recommended, onetime birth-cohort screening for hepatitis C virus (HCV) infection and the development of direct-acting antivirals (DAAs) are expected to reduce HCV-related disease burden in the U.S. To quantify that potential decreased burden, researchers employed an individual-level, state-transition simulation model of the HCV-infected U.S. population from 2001 to 2050, taking into account the new DAA regimens, treatment capacity, and screening policy.
The population was characterized using nationwide U.S. survey data. The simulation assumed treatment with peginterferon plus ribavirin with or without protease inhibitor (triple therapy) between 2013 and 2014, the first-wave, next-generation all-oral regimens after 2014 (sofosbuvir- and simeprevir-based therapies), which would achieve cure rates of 90% in patients without cirrhosis, and the second-wave, next-generation therapy beginning in 2017, which would achieve cure rates of 90% in patients with and without cirrhosis. Outcome measures were prevalence of chronic HCV infection and liver-related outcomes.
A validation analysis showed that model predictions closely matched actual reported results for prevalence of HCV infection, incidence of liver-related complications, and deaths during 2003 to 2010. Based on the model, implementation of onetime birth-cohort screening beginning in 2013 would identify 487,000 new HCV cases during the next 10 years, and with the added availability of highly effective DAA regimens, HCV infection could become a rare disease (affecting ≤1 in 1500 people) by 2036. In addition, 124,200 cases of decompensated cirrhosis, 78,800 cases of liver cancer, 126,500 liver-related deaths, and 9900 liver transplantations would be prevented by 2050.
CITATION(S):
Kabiri M et al. The changing burden of hepatitis C virus infection in the United States: Model-based predictions. Ann Intern Med 2014 Aug 5; 161:170.
