Chronic hepatitis C virus (HCV) disease burden and cost in the United States

Abstract

Hepatitis C virus (HCV) infection is a leading cause of cirrhosis, hepatocellular carcinoma, and liver transplantation. A better understanding of HCV disease progression and the associated cost can help the medical community manage HCV and develop treatment strategies in light of the emergence of several potent anti-HCV therapies. A system dynamic model with 36 cohorts was used to provide maximum flexibility and improved forecasting. New infections incidence of 16,020 (95% confidence interval, 13,510-19,510) was estimated in 2010. HCV viremic prevalence peaked in 1994 at 3.3 (2.8-4.0) million, but it is expected to decline by two-thirds by 2030. The prevalence of more advanced liver disease, however, is expected to increase, as well as the total cost associated with chronic HCV infection. Today, the total cost is estimated at $6.5 ($4.3-$8.4) billion and it will peak in 2024 at $9.1 ($6.4-$13.3) billion. The lifetime cost of an individual infected with HCV in 2011 was estimated at $64,490. However, this cost is significantly higher among individuals with a longer life expectancy.ConclusionThis analysis demonstrates that US HCV prevalence is in decline due to a lower incidence of infections. However, the prevalence of advanced liver disease will continue to increase as well as the corresponding healthcare costs. Lifetime healthcare costs for an HCV-infected person are significantly higher than for noninfected persons. In addition, it is possible to substantially reduce HCV infection through active management.

ABT-450/r–Ombitasvir and Dasabuvir with Ribavirin for Hepatitis C with Cirrhosis

“…2,3 Approximately 25% of persons with HCV infection in the United States have cirrhosis, and this number is expected to rise to 37% by 2020. 4,5 Eradication of HCV with antiviral therapy reduces the risk of hepatic decompensation, hepatocellular carcinoma, and death from a liver-related cause or any cause. [6][7][8][9][10] Among patients with HCV infection and cirrhosis in whom peginterferon-ribavirin treatment has failed, rates of sustained virologic response to retreatment with interferon-containing regimens are as low as 14%.…”

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

“…A previously developed epidemiological model was applied to estimate the time course of changes in the incidence and prevalence of HCV infection [20,21]. The Markov model (implemented in Microsoft Excel [2013]) was used to predict the HCV-infected population and the disease progression from 1950 to 2012.…”

“…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]. The model was also calibrated to account for US populations not captured by the National Health and Nutrition Examination Survey, such as incarcerated and homeless persons.…”

“…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).…”

Hepatitis C virus and proprotein convertase subtilisin/kexin type 9: a detrimental interaction to increase viral infectivity and disrupt lipid metabolism

“…More than 185 million people (~3% of the world's population) are infected by HCV 3 with an incidence rate of HCV infection that is apparently decreasing in the last years 4. HCV infection, mostly in its chronic form, is an important cause of morbidity leading to cirrhosis, end‐stage liver disease and hepatocellular carcinoma 3.…”