Original Research
5 August 2014

The Changing Burden of Hepatitis C Virus Infection in the United States: Model-Based Predictions

Publication: Annals of Internal Medicine
Volume 161, Number 3

Abstract

Background:

Chronic hepatitis C virus (HCV) infection causes a substantial health and economic burden in the United States. With the availability of direct-acting antiviral agents, recently approved therapies and those under development, and 1-time birth-cohort screening, the burden of this disease is expected to decrease.

Objective:

To predict the effect of new therapies and screening on chronic HCV infection and associated disease outcomes.

Design:

Individual-level state-transition model.

Setting:

Existing and anticipated therapies and screening for HCV infection in the United States.

Patients:

Total HCV-infected population in the United States.

Measurements:

The number of cases of chronic HCV infection and outcomes of advanced-stage HCV infection.

Results:

The number of cases of chronic HCV infection decreased from 3.2 million in 2001 to 2.3 million in 2013. One-time birth-cohort screening beginning in 2013 is expected to identify 487 000 cases of HCV infection in the next 10 years. In contrast, 1-time universal screening could identify 933 700 cases. With the availability of highly effective therapies, HCV infection could become a rare disease in the next 22 years. Recently approved therapies for HCV infection and 1-time birth-cohort screening could prevent approximately 124 200 cases of decompensated cirrhosis, 78 800 cases of hepatocellular carcinoma, 126 500 liver-related deaths, and 9900 liver transplantations by 2050. Increasing the treatment capacity would further reduce the burden of HCV disease.

Limitation:

Institutionalized patients with HCV infection were excluded, and empirical data on the effectiveness of future therapies and on the future annual incidence and treatment capacity of HCV infection are lacking.

Conclusion:

New therapies for HCV infection and widespread implementation of screening and treatment will play an important role in reducing the burden of HCV disease. More aggressive screening recommendations are needed to identify a large pool of infected patients.

Primary Funding Source:

National Institutes of Health.

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Supplemental Material

Supplement. Data and Supporting Results and Additional Clinical Scenarios

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Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 161Number 35 August 2014
Pages: 170 - 180

History

Published online: 5 August 2014
Published in issue: 5 August 2014

Keywords

Authors

Affiliations

Mina Kabiri, MS
From the University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and The University of Texas MD Anderson Cancer Center, Houston, Texas.
Alison B. Jazwinski, MD
From the University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and The University of Texas MD Anderson Cancer Center, Houston, Texas.
Mark S. Roberts, MD
From the University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and The University of Texas MD Anderson Cancer Center, Houston, Texas.
Andrew J. Schaefer, PhD
From the University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and The University of Texas MD Anderson Cancer Center, Houston, Texas.
Jagpreet Chhatwal, PhD
From the University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, and The University of Texas MD Anderson Cancer Center, Houston, Texas.
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health.
Acknowledgment: The authors thank Elamin Elbasha, PhD, and Katherine Bornschlegel, MPH, for their constructive comments that improved the quality of the manuscript; John Grefenstette, PhD, for technical support on simulation runs; and Jill Delsigne, PhD, and Diane Hackett for editing the manuscript.
Financial Support: By the National Center for Advancing Translational Sciences, National Institutes of Health (award KL2TR000146). Ms. Kabiri is supported by the Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health.
Reproducible Research Statement: Study protocol: Not applicable. Statistical code and data set: Available from Dr. Chhatwal (e-mail, [email protected]).
Corresponding Author: Jagpreet Chhatwal, PhD, Department of Health Services Research, Unit 1444, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030; e-mail, [email protected].
Current Author Addresses: Ms. Kabiri and Dr. Roberts: Department of Health Policy and Management, 130 De Soto Street, Pittsburgh, PA 15261.
Dr. Jazwinski: Division of Gastroenterology, Hepatology and Nutrition, Center for Liver Diseases, 3471 Fifth Avenue, 900 Kaufmann Building, Pittsburgh, PA 15213.
Dr. Schaefer: Department of Industrial Engineering, 1048 Benedum Hall, University of Pittsburgh, Pittsburgh, PA 15261.
Dr. Chhatwal: Department of Health Services Research, Unit 1444, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030.
Author Contributions: Conception and design: M. Kabiri, A.B. Jazwinski, M.S. Roberts, J. Chhatwal.
Analysis and interpretation of the data: M. Kabiri, M.S. Roberts, A.J. Schaefer, J. Chhatwal.
Drafting of the article: M. Kabiri, A.B. Jazwinski, J. Chhatwal.
Critical revision of the article for important intellectual content: M. Kabiri, A.B. Jazwinski, M.S. Roberts, A.J. Schaefer, J. Chhatwal.
Final approval of the article: M. Kabiri, A.B. Jazwinski, M.S. Roberts, A.J. Schaefer, J. Chhatwal.
Statistical expertise: M. Kabiri, J. Chhatwal.
Obtaining of funding: A.J. Schaefer, J. Chhatwal.
Administrative, technical, or logistic support: M. Kabiri.
Collection and assembly of data: M. Kabiri.

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Mina Kabiri, Alison B. Jazwinski, Mark S. Roberts, et al. The Changing Burden of Hepatitis C Virus Infection in the United States: Model-Based Predictions. Ann Intern Med.2014;161:170-180. [Epub 5 August 2014]. doi:10.7326/M14-0095

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