Abstract
Oral
direct-acting antivirals (DAAs) represent a major advance in hepatitis C
virus (HCV) treatment. Along with recent updates in HCV screening
policy and expansions in insurance coverage, the treatment demand in the
United States is changing rapidly. Our objective was to
project the characteristics and number of people needing antiviral
treatment, and HCV-associated disease burden in the era of oral DAAs. We
used a previously developed and validated Hepatitis C Disease Burden
Simulation model (HEP-SIM). HEP-SIM simulated the actual clinical
management of HCV from 2001 onwards, which included antiviral treatment
with peginterferon-based therapies as well as the recent oral DAAs,
risk-based and birth-cohort HCV screening, and the impact of the
Affordable Care Act. We also simulated two hypothetical scenarios—no
treatment and treatment with peginterferon-based therapies only. We
estimated that in 2010, 2.5 (95% CI: 1.9-3.1) million
non-institutionalized people were viremic, which dropped to 1.9 (95% CI:
1.4-2.6) million in 2015, and projected to drop below 1 million by
2020. A total of 1.8 million HCV patients will receive HCV treatment
from the launch of oral DAAs in 2014 until 2030. Based on current HCV
management practices, it will take 4-6 years to treat the majority of
patients aware of their disease. However, 560,000 patients would still
remain unaware by 2020. Even in the oral DAA era, 320,000 patients will
die, 157,000 will develop hepatocellular carcinoma, and 203,000 will
develop decompensated cirrhosis in the next 35 years. Conclusions:
HCV-associated disease burden will still remain substantial in the era
of oral DAAs. Increasing HCV screening and treatment capacity is
essential to further decreasing HCV burden in the United States. This
article is protected by copyright. All rights reserved.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.