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Chronic hepatitis C virus (HCV) burden in Rhode Island: modelling treatment scale-up and elimination
A I Soipe1, H Razavi2, D Razavi-Shearer2
1Department of Epidemiology,Brown University School of Public Health,Providence,RI,USA.
Insights
Scaling up Hepatitis C Virus (HCV) treatment in Rhode Island, especially with no fibrosis criteria, significantly reduces cirrhosis and liver deaths. Achieving HCV elimination requires treating over 2000 patients annually.
Area of Science:
- Hepatology and Public Health
- Infectious Disease Modeling
- Health Economics and Policy
Background:
- Hepatitis C Virus (HCV) infection poses a significant public health burden, leading to cirrhosis and liver-related mortality.
- Current treatment paradigms and reimbursement criteria in Rhode Island (RI) limit access to care.
- Disease progression models are crucial for evaluating the impact of interventions on HCV outcomes.
Purpose of the Study:
- To model the impact of different Hepatitis C Virus (HCV) treatment scale-up scenarios on disease progression in Rhode Island.
- To assess the effect of varying Medicaid reimbursement criteria on cirrhotic cases and liver-related deaths.
- To determine the treatment scale required to achieve HCV elimination by 2030.
Main Methods:
- Utilized a disease progression model to simulate HCV viraemic infections, cirrhotic cases, and liver-related deaths.
- Evaluated four distinct treatment scenarios, including current practices and expanded treatment criteria (fibrosis stages ⩾F3, ⩾F2, ⩾F0).
- Modeled an 'elimination' scenario targeting over 90% reduction in viraemic cases by 2030.
Main Results:
- Under current treatment, cirrhotic cases and liver deaths are projected to plateau and peak by 2030.
- Treatment scale-up with ⩾F2 and ⩾F0 fibrosis criteria could reduce cirrhosis by 21.7% and 10.0%, and deaths by 19.3% and 7.4% by 2030, respectively.
- Achieving >90% reduction in viraemic cases requires treating >2000 patients annually by 2020, reducing cirrhosis by 78.9% and deaths by 72.4% by 2030.
Conclusions:
- Increased Hepatitis C Virus (HCV) treatment uptake is essential for substantially reducing the disease burden in Rhode Island.
- Less restrictive reimbursement criteria and immediate treatment scale-up significantly mitigate long-term HCV-related morbidity and mortality.
- An aggressive treatment scale-up strategy is necessary to achieve HCV elimination goals by 2030.
Abstract:
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.
