BACKGROUND: Chronic infection with hepatitis C virus (HCV) is a major cause of cirrhosis, hepatocellular carcinoma and liver transplantation. OBJECTIVE: To estimate the burden of HCV-related disease and costs from a Canadian perspective. METHODS: Using a system dynamic framework, the authors quantified the HCV-infected population, disease progression and costs in Canada between 1950 and 2035. Specifically, 36 hypothetical, age- and sex-defined cohorts were tracked to define HCV prevalence, complications and direct medical costs (excluding the cost of antivirals). Model assumptions and costs were extracted from the literature with an emphasis on Canadian data. No incremental increase in antiviral treatment over current levels was assumed, despite the future availability of potent antivirals. RESULTS: The estimated prevalence of viremic hepatitis C cases peaked in 2003 at 260,000 individuals (uncertainty interval 192,460 to 319,880), reached 251,990 (uncertainty interval 177,890 to 314,800) by 2013 and is expected to decline to 188,190 (uncertainty interval 124,330 to 247,200) in 2035. However, the prevalence of advanced liver disease is increasing. The peak annual number of patients with compensated cirrhosis (n=36,210), decompensated cirrhosis (n=3380), hepatocellular carcinoma (n=2220) and liver-related deaths (n=1880) are expected to occur between 2031 and 2035. During this interval, an estimated 32,460 HCV-infected individuals will die of liver-related causes. Total health care costs associated with HCV (excluding treatment) are expected to increase by 60% from 2013 until the peak in 2032, with the majority attributable to cirrhosis and its complications (81% in 2032 versus 56% in 2013). The lifetime cost for an individual with HCV infection in 2013 was estimated to be $64,694. CONCLUSIONS: Although the prevalence of HCV in Canada is decreasing, cases of advanced liver disease and health care costs continue to rise. These results will facilitate disease forecasting, resource planning and the development of rational management strategies for HCV in Canada.
BACKGROUND:Chronic infection with hepatitis C virus (HCV) is a major cause of cirrhosis, hepatocellular carcinoma and liver transplantation. OBJECTIVE: To estimate the burden of HCV-related disease and costs from a Canadian perspective. METHODS: Using a system dynamic framework, the authors quantified the HCV-infected population, disease progression and costs in Canada between 1950 and 2035. Specifically, 36 hypothetical, age- and sex-defined cohorts were tracked to define HCV prevalence, complications and direct medical costs (excluding the cost of antivirals). Model assumptions and costs were extracted from the literature with an emphasis on Canadian data. No incremental increase in antiviral treatment over current levels was assumed, despite the future availability of potent antivirals. RESULTS: The estimated prevalence of viremic hepatitis C cases peaked in 2003 at 260,000 individuals (uncertainty interval 192,460 to 319,880), reached 251,990 (uncertainty interval 177,890 to 314,800) by 2013 and is expected to decline to 188,190 (uncertainty interval 124,330 to 247,200) in 2035. However, the prevalence of advanced liver disease is increasing. The peak annual number of patients with compensated cirrhosis (n=36,210), decompensated cirrhosis (n=3380), hepatocellular carcinoma (n=2220) and liver-related deaths (n=1880) are expected to occur between 2031 and 2035. During this interval, an estimated 32,460 HCV-infected individuals will die of liver-related causes. Total health care costs associated with HCV (excluding treatment) are expected to increase by 60% from 2013 until the peak in 2032, with the majority attributable to cirrhosis and its complications (81% in 2032 versus 56% in 2013). The lifetime cost for an individual with HCV infection in 2013 was estimated to be $64,694. CONCLUSIONS: Although the prevalence of HCV in Canada is decreasing, cases of advanced liver disease and health care costs continue to rise. These results will facilitate disease forecasting, resource planning and the development of rational management strategies for HCV in Canada.
Authors: Soo Aleman; Nogol Rahbin; Ola Weiland; Loa Davidsdottir; Magnus Hedenstierna; Nina Rose; Hans Verbaan; Per Stål; Tony Carlsson; Hans Norrgren; Anders Ekbom; Fredrik Granath; Rolf Hultcrantz Journal: Clin Infect Dis Date: 2013-04-24 Impact factor: 9.079
Authors: Hla-Hla Thein; Wanrudee Isaranuwatchai; Michael A Campitelli; Jordan J Feld; Eric Yoshida; Morris Sherman; Jeffrey S Hoch; Stuart Peacock; Murray D Krahn; Craig C Earle Journal: Hepatology Date: 2013-03-15 Impact factor: 17.425
Authors: Conar R O'Neil; Emily Buss; Sabrina Plitt; Mariam Osman; Carla S Coffin; Carmen L Charlton; Stephen Shafran Journal: Can J Public Health Date: 2019-06-20
Authors: Robert P Myers; Pam Crotty; Susanna Town; Janine English; Kevin Fonseca; Raymond Tellier; Mark G Swain; S Elizabeth McGregor; Steven J Heitman; Robert J Hilsden Journal: CMAJ Open Date: 2015-01-13
Authors: Lianping Ti; Viviane Lima; Mark Hull; Bohdan Nosyk; Jeffrey Joy; Julio Montaner; Mel Krajden; Richard Harrigan; Thomas Kerr; Kate Shannon; Evan Wood; Jean Shoveller; Alnoor Ramji; Hin Hin Ko; Eric Yoshida; David Hall; Rolando Barrios Journal: CMAJ Date: 2017-06-26 Impact factor: 8.262
Authors: Chaturaka Rodrigo; Auda A Eltahla; Rowena A Bull; Jason Grebely; Gregory J Dore; Tanya Applegate; Kimberly Page; Julie Bruneau; Meghan D Morris; Andrea L Cox; William Osburn; Arthur Y Kim; Janke Schinkel; Naglaa H Shoukry; Georg M Lauer; Lisa Maher; Margaret Hellard; Maria Prins; Chris Estes; Homie Razavi; Andrew R Lloyd; Fabio Luciani Journal: J Infect Dis Date: 2016-08-28 Impact factor: 5.226
Authors: M Eugenia Socías; Kate Shannon; Julio S Montaner; Silvia Guillemi; Sabina Dobrer; Paul Nguyen; Shira Goldenberg; Kathleen Deering Journal: Can J Gastroenterol Hepatol Date: 2015-10-22