Estimation of fibrosis progression rates for chronic hepatitis C: a systematic review and meta-analysis update

Abstract

ObjectivesMathematical models are increasingly important in planning for the upcoming chronic hepatitis C (CHC) elimination efforts. Such models require reliable natural history inputs to make accurate predictions on health and economic outcomes. Yet, hepatitis C virus disease progression is known to vary widely in the literature and published inputs are currently outdated. The objectives of this study were to obtain updated estimates of fibrosis progression rates (FPR) in treatment-naïve patients with CHC and to explore sources of heterogeneity.DesignA systematic review was conducted using Ovid-MEDLINE, Ovid-EMBASE and PubMed databases (January 1990 to January 2018) to identify observational studies of hepatic fibrosis in treatment-naïve patients with CHC.OutcomesStage-constant FPRs were estimated for each study given the reported fibrosis scores and duration of infection. Stage-specific FPRs (ie, F0→F1; F1→F2; F2→F3; F3→F4) were estimated using Markov maximum likelihood estimation. Estimates were pooled using random-effects meta-analysis and heterogeneity was evaluated by stratification and random-effects meta-regression.ResultsThe review identified 111 studies involving 131 groups of patients (n=42 693). The pooled stage-constant FPR was 0.094 (95% CI 0.088 to 0.100); stage-specific FPRs were F0→F1: 0.107 (95% CI 0.097 to 0.118); F1→F2: 0.082 (95% CI 0.074 to 0.091); F2→F3: 0.117 (95% CI 0.107 to 0.129); F3→F4: 0.116 (95% CI 0.104 to 0.131). Stratified analysis revealed substantial variation in progression by study population. Meta-regression indicated associations between progression and infection age, duration, source, viral genotype and study population. Findings indicate that FPRs display substantial heterogeneity across study populations and pooled values from more homogenous subpopulations should be considered when estimating prognosis.ConclusionsThis large meta-analysis presents updated prognostic estimates for CHC derived from newer studies using better diagnostic methods and improves estimates for important patient populations in terms of clinical policy (eg, injection drug users, non-clinical populations, liver clinic patients) and should be a valuable resource for patients, clinicians and clinical policymakers.

Health care costs associated with hepatitis C virus infection in First Nations populations in Ontario: a retrospective matched cohort study

“…By excluding case participants with HIV and HBV infection, our study estimates reflect the cost of diagnosed monoinfection. Coinfection has been associated with potentially rapid fibrosis progression 44 and different treatment of infection. Coinfection with HIV in particular has been associated with increased health care costs.…”

The emergency department as a setting‐specific opportunity for population‐based hepatitis C screening: An economic evaluation

“…Although novel antiviral treatment regimens have made chronic HCV infection curable, there is some urgency to find and treat these individuals before cirrhosis and hepatocellular carcinoma (HCC)can develop 1 . Without treatment, it is estimated that of those infected, over 41% will develop liver cirrhosis 4 …”

Treatment of Chronic Hepatitis C in Young Children Reduces Adverse Outcomes and Is Cost-Effective Compared with Deferring Treatment to Adulthood

“…In our model, fibrosis progression rates were obtained from a recently conducted systematic review of the world literature describing HCV prognosis. 10 In contrast to the study by Nguyen et al, we have incorporated fibrosis progression rates specific to patients infected with HCV as children to more accurately simulate the natural history of HCV in this population. Also, in contrast to the study by Nguyen et al, our model incorporates high quality, longitudinal, contemporary cost data specific to children in the early stages of disease.…”

“…Cohort characteristics, model inputs and assumptions used to inform our model are summarized in Table I. [10][11][12][13][14][15][16][17][18][19] Disease-Progression Rates. Fibrosis progression rates from fibrosis stages F0 through to F4, specific to patients infected as children, were derived from a recently conducted systematic review.…”

“…Fibrosis progression rates from fibrosis stages F0 through to F4, specific to patients infected as children, were derived from a recently conducted systematic review. 4,10,20 Probabilities for transition from F4 to decompensated cirrhosis, hepatocellular carcinoma (HCC), and liver transplantation were taken from the published literature. 11,12 Mortality.…”