CHRONIC HEPATITIS C VIRUS DISEASE BURDEN AND COST IN U.S.

.....the
"incidence of more advanced liver diseases will  continue to increase, with
incidence of decompensated cirrhosis and HCC peaking  in
2016-2017......by
2030, compensated cirrhosis cases will account for  37% of all prevalent cases.
The HCV compensated cirrhotic population is  projected to peak in 2015, while
the decompensated cirrhotic population will  peak in 2019”


"The effects of new
therapies were excluded from our  model. However, if the number of treated
patients is doubled and kept constant  at 126,000 per year in 2012-2030 and the
average SVR is increased to 70%, the  2030 prevalent population is projected to
be less than 100,000 cases. This  illustrates that it is possible to
substantially reduce HCV infection in the US  through active
management."



Hepatology  Accepted Article Dec 22
2012


H. Razavi1,
A. El Khoury2,
E. Elbasha2,
C. Estes1,
K. Pasini1,
T. Poynard3,
R. Kumar2
1. Center for Disease Analysis, Louisville,
Colorado, USA
2. Merck, Sharp, & Dohme Corp., Whitehouse
Station, NJ
3. Université Pierre et Marie Curie Liver
Center, Paris,  France


"The goal of this study is to
describe the future disease  and cost burden of HCV infection in the United
States using a systems approach,  assuming there is no incremental increase in
treatment as the result of the new  therapies......In conclusion, our analysis
demonstrated that overall HCV  prevalence in the US is in decline due to lower
incidence. However, the
prevalence of advanced liver disease will  continue to increase,
as will  the corresponding healthcare
costs......we
forecast that mortality will continue to increase  and peak in
2020.....Patients experiencing decompensated cirrhosis
  accounted for the majority of future costs Lifetime healthcare costs for an  HCV infected person
are significantly higher than for non-infected persons, and  the expected cost
is higher among populations with a higher life expectancy.  Finally, it is
possible to substantially reduce HCV infection in the US  through active
management.......the prevalence of
more advanced liver diseases has been  increasing. The prevalent
population with compensated cirrhosis is  projected to peak in 2015 at 626,500
cases, while the population  with decompensated cirrhosis will peak in 2019 with
107,400 cases. The number of  individuals with HCC, caused by HCV infection,
will increase to 23,800 cases in  2018 before starting to decline. In 2011, the
total healthcare cost associated  with HCV infection was $6.5 ($4.3-$8.2)
billion.......Total cost is expected to peak  in 2024 at $9.1
billion ($6.4-$13.3 billion), as shown in Figure  3. The majority of
peak cost will be attributable to more  advanced liver diseases—decompensated
cirrhosis (46%), compensated cirrhosis  (20%), and hepatocellular carcinoma
(16%). The maximum cost associated with mild  to moderate fibrosis (F0-F3)
occurred in 2007 at nearly $780 million. The cost  associated with compensated
cirrhosis is expected to peak in 2022 at $1.9  billion, while the peak cost for
decompensated cirrhosis and HCC is predicted to  occur in 2025, with annual
costs in excess of $4.2 billion and $1.4 billion  respectively.”