Abstract
Catalyzed by the concerns over the growing public health and economic burden of Hepatitis C virus (HCV) in Switzerland, a diverse group of experts and patient representatives came together in 2014 to develop the Swiss Hepatitis Strategy, setting targets for the elimination of viral hepatitis in Switzerland by 2030. Previous studies have reported the estimated number of chronic HCV infections and forecasted burden of disease given different intervention strategies. However, given new prevalence data by the Swiss Federal Office of Public Health, which decreased total infections by about half, an updated analysis is warranted. We aimed to provide an updated viremic prevalence estimate for Switzerland and evaluate the impact on forecasted liver related morbidity and mortality of an ‘inaction’ scenario and intervention scenarios to achieve the Global Health Sector Strategy for Viral Hepatitis and Swiss Hepatitis Strategy goals by 2030. A Markov disease-progression model was used to calculate the present and future burden of HCV infection by disease stage according to these different strategies. In 2017, there were an estimated 36,800 (95% UI: 26,900–39,200) viremic infections in Switzerland. Given the current standard of care, total viremic infections are expected to decline by 45%, while cases of decompensated cirrhosis, hepatocellular carcinoma, and liver-related deaths will decrease by 20%. If treatment and diagnosis efforts were to cease in 2018, late stage HCV-related morbidity and mortality would increase by 90–100% by 2030. Increasing treatment and diagnosis to achieve the Global Health Sector Strategy or Swiss Hepatitis Strategy goals by 2030, will reduce the number of chronic infections to less than 13,000 and 4,000, respectively. Although the HCV epidemic is declining in Switzerland, efforts to expand diagnosis and treatment are needed to achieve elimination by 2030.
Highlights
In 2014, we conducted a study to expand modeling efforts and assist in the development of a national strategy for hepatitis C virus (HCV) control in Switzerland [1]
Liver cancer data reported to National Institute for Cancer Epidemiology and Registration (NICER) from 1999 to 2013 were adjusted for HCV-attributable hepatocellular carcinoma (HCC) cases based on histology data from the Geneva Tumor Registry [13], and were used to validate modelled HCC trends (S1 File)
These efforts have initiated an increase in research, analyses and forecasts, which require updates to our original modeling efforts
Summary
In 2014, we conducted a study to expand modeling efforts and assist in the development of a national strategy for hepatitis C virus (HCV) control in Switzerland [1]. Results published in 2017, estimated 36,000–43,000 HCV-RNA positive cases in 2016, corresponding to a 0.45%– 0.54% viremic prevalence, after accounting for mortality and cured patients [7]. In light of this new information, our disease burden model was revisited, incorporating updated data on HCV diagnosis, treatment and sustained viral response (SVR) from 2014 through 2017. The outcome is an up-to-date forecast of prevalence and end-stage outcomes associated with HCV This analysis seeks to highlight the gains that have been made since the formulation and launching of the Swiss Hepatitis Strategy (SHS) initiative in 2014 [8]. Authors tracked Switzerland’s progress toward achieving the Global Health Sector Strategy (GHSS) targets for the elimination of HCV as a public health threat by 2030 of a 65% reduction in mortality; 90% diagnosis coverage of the infected population; and a 90% reduction in new infections [9] (S1 Table)
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