Number Of Liver-related Deaths Research Articles

Бремя вирусного гепатита С в Российской Федерации: от реальной ситуации к стратегии

Objective. To model the current and future impact of the chronic hepatitis C disease burden if the current treatment paradigm continues and is effective and if WHO strategy is implemented successfully. Materials and methods. A dynamic disease progression model was constructed in Microsoft Excel (Microsoft Corp., USA) in collaboration with CDA (Center for Disease Analysis, USA) similar to that used in previous studies. As no accurate data on HCV prevalence in Russia and its federal subjects is available, calculations were based on the prevalence of 2.5% and 4.1%. Results. The modelling suggests that, unless the treatment paradigm is changed, the chronic hepatitis C prevalence will remain the same, whereas the mortality and the rate of other HCV-related outcomes (HCC, decompensated cirrhosis) will more than double by 2030. Achieving WHO global strategy targets in Russia will help reduce the total number of infected individuals by 90% and the number of liver-related deaths by 65% saving >45,000 or >77,000 lives under the scenarios with 2.5% and 4.1% prevalence respectively. However, such trends will only take place if WHO strategy is implemented successfully. Conclusion. Regardless of the epidemiologic input data, elimination of HCV infection in Russia appears feasible; however, it requires financial support from the government and a range of organizational measures. Key words: HCV infection, chronic HCV infection, WHO strategy, antiviral therapy

Public health impact of comprehensive hepatitis C screening and treatment in the French baby-boomer population

Objective: To estimate the public health impact of comprehensive hepatitis C virus (HCV) screening and access to all-oral, interferon (IFN)-free direct-acting antivirals (DAAs) in the French baby-boomer population (1945–1965 birth cohorts).Methods: A sequential, multi-cohort, health-state transition model was developed to assess the impact of different hepatitis C screening and treatment strategies on clinical and economic outcomes in the 1945–1965 birth cohorts. Patients newly-diagnosed with chronic HCV were projected each year from 2016 to 2036 under three screening scenarios (70% [low], 75% [intermediate], and 80% [high] HCV awareness in 2036). Healthcare costs and clinical outcomes (number of liver-related deaths, quality-adjusted life-years [QALYs], life-years [LYs] spent in sustained virologic response [SVR] or with decompensated cirrhosis, hepatocellular carcinoma, or liver transplant) were compared among five treatment strategies (no antiviral therapy; IFN + ribavirin + protease inhibitor for fibrosis stages F2–F4, IFN-based DAAs for stages F2–F4, IFN-free DAAs for stages F2–F4, and IFN-free DAAs for stages F0–F4).Results: Diagnosis of HCV genotype 1 was projected for 4,953, 6,600, and 8,368 individuals in the low, intermediate, and high screening scenarios, respectively. In the intermediate scenario, IFN-free DAAs for stages F0–F4 had a favorable cost-effectiveness profile vs IFN-based or IFN-free treatment strategies for F2–F4 and offered the greatest return on investment (0.899 LYs gained in SVR and 0.933 QALYs per €10,000 invested).Conclusion: Comprehensive HCV screening and access to all-oral, IFN-free DAAs is a cost-effective strategy that could help diminish the upcoming burden of HCV in the French baby-boomer population.

Chronic hepatitis C virus (HCV) burden in Rhode Island: modelling treatment scale-up and elimination.

We utilized a disease progression model to predict the number of viraemic infections, cirrhotic cases, and liver-related deaths in the state of Rhode Island (RI) under four treatment scenarios: (1) current HCV treatment paradigm (about 215 patients treated annually, Medicaid reimbursement criteria fibrosis stage ⩾F3); (2) immediate scale-up of treatment (to 430 annually) and less restrictive Medicaid reimbursement criteria (fibrosis stage ⩾F2); (3) immediate treatment scale-up and no fibrosis stage-specific Medicaid reimbursement criteria (⩾F0); (4) an 'elimination' scenario (i.e. a continued treatment scale-up needed to achieve >90% reduction in viraemic cases by 2030). Under current treatment models, the number of cirrhotic cases and liver-related deaths will plateau and peak by 2030, respectively. Treatment scale-up with ⩾F2 and ⩾F0 fibrosis stage treatment criteria could reduce the number of cirrhotic cases by 21·7% and 10·0%, and the number of liver-related deaths by 19·3% and 7·4%, respectively by 2030. To achieve a >90% reduction in viraemic cases by 2030, over 2000 persons will need to be treated annually by 2020. This strategy could reduce cirrhosis cases and liver-related deaths by 78·9% and 72·4%, respectively by 2030. Increased HCV treatment uptake is needed to substantially reduce the burden of HCV by 2030 in Rhode Island.

Su1035 Treating Chronic Hepatitis C Infection in the Elderly: Estimated Impact on Life Expectancy

Hepatitis C virus (HCV) infection continues to be a significant contributor to morbidity and mortality in the United States and throughout the world. Due to latency of infection, HCV is expected to cause an increasing number of liver-related deaths over the next 10 years despite a dramatic drop in incidence over the last 20 years. The present recommended treatment for patients with chronic HCV infection is triple therapy with pegylated interferon α, ribavirin and a protease inhibitor (PI). There are no guidelines for treatment in the elderly (defined as 65 years and older). As the largest cohort with HCV ages, it has become critical to evaluate the effect of treatment on life expectancy in elderly patients. We used a simple decision analysis model to simulate the impact of HCV treatment on life expectancy. Cohorts separated by gender entered the model at five age groups (60 to 80) and at the five stages of liver fibrosis (F0 to F4). The primary outcome was mean life expectancy and number of life years gained. Hazard ratios for all-cause mortality in cirrhosis before and after achieving sustained virologic response (SVR) were applied to baseline annual mortality rates to obtain F4-specific mortality rates. Sensitivity analysis was performed to ensure results were robust over a wide range of values. Our model demonstrated that the greatest life expectancy benefit of treatment was derived from treatment of younger patients with higher levels of fibrosis. Overall, men benefitted more than woman, with equalization of this benefit in cirrhosis. In our base-case scenario with a SVR rate of 70%, the mean years of life expectancy gained across all ages and stages of fibrosis were 2.18 years for women and 2.95 years for men. Based on a treatment threshold of 6 months of life expectancy gained, only men between 60 and 70 should be treated in the F0 cohort. From F2 and above, all cohorts reached our threshold value. The rate of SVR affected number of life years gained but did not substantially alter treatment decisions. Elderly patients have higher rates of progression of liver fibrosis and are more likely to present with complications of liver disease. Although prior studies on treatment of patients older on 65 are limited, data exists that these patients respond with similar rates of SVR as younger patients. Furthermore, recent studies have shown a clear decrease in liver-related morbidity and mortality if SVR is achieved. Given our findings of improved survival, this study highlights the importance of treatment in this at-risk cohort especially as shorter regimens and higher SVR rates are anticipated with upcoming PIs. Our results provide evidence for consideration of HCV treatment in clinical practice for all men between 60and 70-years of age and any patient of either gender with advanced fibrosis or cirrhosis. Life expectancy gains and treatment recommendations stratified by age, gender and fibrosis

Management of hepatitis C in human immunodeficiency virus-infected patients.

Hepatitis C virus-related liver disease and its associated complications are steadily emerging health concerns in persons co-infected with human immunodeficiency virus. The increasing number of liver-related deaths in human immunodeficiency virus-hepatitis C virus co-infected individuals supports the compelling argument for more aggressive treatment in these patients. The safety and efficacy of interferon/ribavirin in human immunodeficiency virus/hepatitis C virus co-infected patients is currently under evaluation. Despite well-documented concern over highly active antiretroviral therapy-associated hepatotoxicity human immunodeficiency virus/hepatitis C virus co-infected patients should be offered antiretroviral therapy. Since management of co-infected patients is complex a multidisciplinary approach is needed in order to facilitate care and help patients to achieve a positive outcome.

Why and how to treat chronic hepatitis C.

Chronic hepatitis C (CHC) is a major health problem worldwide, with approximately 200 million affected individuals and a significant rate of progression to end-stage cirrhosis and hepatocellular carcinoma (HCC). If hepatitis C virus (HCV) infection is left untreated in the population, then the number of liver-related deaths will soon double and the need for liver transplantation may increase to five times that seen today. Available therapies for CHC are restricted to interferon alpha (IFN alpha) monotherapy and to the combination of IFN alpha and ribavirin. Despite their high cost and side effects, both of these therapies have proved to be cost effective, particularly combination therapy. IFN alpha monotherapy for one year can induce sustained response (SR) rates of approximately 10% in naive patients infected with HCV genotype 1, and above 50% in those infected with other genotypes. Combination therapy can double or even triple the rate of SR in genotype 1 infections and may further increase the SR rate in the other HCV genotypes. Combination therapy has also been proven to be effective in approximately 50% of relapsed responders to IFN alpha monotherapy. In clinical practice, the decision to treat should be individualized and tailored on the basis of several virus- and host-related factors, particularly the grade and stage of liver disease, HCV genotype and levels of viremia. Appropriate monitoring of therapy by careful clinical evaluation, liver biochemistry and serum HCV RNA testing is mandatory. IFN alpha therapy may also prove to be effective in reducing the rate of HCC development in CHC regardless of whether a virological response is achieved, but this remains to be established.