MAKING HEPATITIS C A RARE DISEASE IN THE UNITED STATES: MODEL-BASED PREDICTIONS
Candidate for the Lee B. Lusted Student Prize Competition
Purpose: Chronic hepatitis C virus (HCV) is the leading cause of chronic liver disease and liver transplantation, affecting more than 3 million Americans. The launch of new direct-acting antivirals and recent updates in HCV screening are expected to transform the landscape of HCV. The aim of our study was to project the effects of recent therapeutic advances and updates in HCV screening on the burden of HCV disease in the United States.
Methods: We developed an individual-level state-transition model that simulated the HCV-infected population of the United States from 2001 to 2050. The states of our model included the chronic stages of infection, decompensated cirrhosis, hepatocellular carcinoma, liver-related death, and liver transplantation. Based on the HCV genotype and year, we assigned treatments with the old drugs until 2013, recently approved drugs beginning 2014, and potential new therapies in two waves beginning 2017 and 2020. In addition, we included one-time birth cohort screening as recommended by the Centers for Disease Control and Prevention (CDC). We also simulated an "ideal" scenario that assumed one-time universal screening and unlimited treatment capacity. The treatment efficacy was assigned according to HCV genotype, METAVIR fibrosis score (F0–F4), treatment history, and interferon-intolerance. We validated our model against published data from the CDC, NHANES 1999–2002, and NHANES 2003–2010.
Results: Our model projected that the prevalence of chronic HCV in the United States decreased from 3.2 million in 2001 to 2.3 million in 2013 (Figure 1). We projected that HCV would become a rare disease by 2036 with the availability of new direct-acting antivirals and screening updates. One-time birth-cohort screening is expected to identify 487,000 HCV cases in the next 10 years. Under the ideal scenario, HCV could become a rare disease by 2026, and the implementation of one-time universal screening could identify 933,700 HCV cases in the next 10 years.
Conclusions: With ongoing therapeutic advancements and screening policy changes, HCV could become a rare disease within the next 22 years. The current screening recommendations are helpful in decreasing the future burden of HCV, but more aggressive recommendations in conjunction with an increase in HCV treatment capacity can further accelerate this process.
Figure 1. The estimated prevalence of chronic hepatitis C virus cases in the United States from 2001 to 2050.