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Simulation of hepatitis C based on a mandatory reporting system
Markus Sagmeister1, Eberhard L Renner, Beat Mullhaupt
1Division of Gastroenterology and Hepatology, University Hospital, Zürich, Switzerland.
Insights
Hepatitis C virus (HCV) infection prevalence in Switzerland is higher than previously estimated. Despite decreasing new infections, HCV-related disease burden and costs will significantly increase until 2020.
Area of Science:
- Hepatology
- Epidemiology
- Public Health
Background:
- Hepatitis C is a significant cause of liver disease in Europe.
- Accurate assessment of hepatitis C burden is crucial for public health planning.
Purpose of the Study:
- To assess the current and future disease burden of hepatitis C in Switzerland.
- To estimate hepatitis C prevalence, morbidity, mortality, and associated costs.
Main Methods:
- Utilized a unique epidemiological database from mandatory reporting of hepatitis C virus (HCV) test results and physician-collected clinical data in Switzerland.
- Applied a validated computer model simulating the natural history of HCV infection.
- Estimated age distribution of acute and chronic HCV infections, prevalence, future morbidity/mortality (cirrhosis, hepatocellular carcinoma), and costs.
Main Results:
- Estimated anti-HCV prevalence in Switzerland at 1.25-1.75%, exceeding prior reports.
- Predicted a 70-90% increase in HCV-related morbidity and mortality, peaking between 2015-2020, driven by prevalent cases from 1998.
- Antiviral treatment demonstrated a modest 5% reduction in disease burden.
- Projected annual direct costs to more than double, reaching nearly US$33 million by 2020.
Conclusions:
- HCV-related cirrhosis incidence is expected to decline post-2005-2010.
- Disease burden and complication costs associated with hepatitis C are projected to rise until 2015-2020.
Objective:
Hepatitis C is a major cause of liver disease in European countries. We aimed to assess the current and future disease burden of hepatitis C.
Setting:
A representative data set of hepatitis C was applied to a validated computer model.
Methods:
The mandatory reporting of positive hepatitis C virus (HCV) test results by all medical laboratories in Switzerland and the clinical data obtained by questionnaire for each positive test from the treating physicians created a unique, representative epidemiological database allowing the determination of the age distribution of acute (i.e. newly acquired) and chronic HCV infections. Based on these data and a simulation model of the natural history of hepatitis C, we estimated the prevalence of HCV infection, future morbidity/mortality from cirrhosis/hepatocellular carcinoma and costs.
Results:
Our analysis estimates a prevalence of anti-HCV in Switzerland of 1.25-1.75%, which is slightly higher than prior reports (0.5-1%) derived by extrapolation from selected populations. Although new HCV infections decreased after 1990, our analysis predicts that HCV-related morbidity and mortality will increase by 70-90%, reaching a maximum in 2015-2020, largely from complications in cases already prevalent in 1998. The model predicts that the incidence of cirrhosis will begin to decrease after 2005-2010. Antiviral treatment reduces disease burden by approximately 5%. Undiscounted HCV-related annual direct costs will more than double and reach a maximum of almost US$33 million in 2020.
Conclusions:
The incidence of HCV-related cirrhosis is predicted to decrease after 2005-2010, while disease burden and costs due to complications are estimated to continue to increase until 2015-2020.