The Impact of Hepatitis C Burden
Background. Infection with the hepatitis C virus (HCV) has been considered a major cause of mortality, morbidity and resource utilisation in the US. In addition, HCV is the main cause of hepatocellular cancer (HCC) in the US. Recent developments in the diagnosis and treatment of HCV, including new recommendations pertaining to screening for HCV by the Centers for Disease Control and Prevention and newer treatment regimens with high efficacy, short duration and the potential for interferon-free therapies, have energised the health care practitioners regarding HCV management.
Aim. To assess the full impact of HCV burden on clinical, economic and patient-reported outcomes.
Methods. An expert panel was convened to assess the full impact of HCV burden on a number of important outcomes using an evidence-based approach predicated on Grading of Recommendations Assessment, Development and Evaluation methodology. The literature was summarised, graded using an evidence-based approach and presented during the workshop. Workshop presentations were intended to review recent, relevant evidence-based literature and provide graded summary statements pertaining to HCV burden on topics including the relationships between HCV and the development of important outcomes.
Results. The associations of HCV with cirrhosis, HCC, liver-related mortality, type 2 diabetes mellitus, rheumatological diseases and quality of life impairments are supported by strong evidence. Also, there is strong evidence that sustained viral eradication of HCV can improve important outcomes such as mortality and quality of life.
Conclusions. The current evidence suggests that HCV has been associated with tremendous clinical, economic and quality of life burden.
In the US, hepatitis C virus (HCV)-associated disease has been considered the leading indication for liver transplantation and the leading cause of hepatocellular cancer (HCC). In addition to liver disease, HCV infection is suspected to be associated with a number of extrahepatic manifestations. Chronic hepatitis C and its sequelae are associated with increased cause-specific and overall mortality. A recent Centers for Disease Control and Prevention (CDC) review of death certificate data found that the hepatitis C mortality rate increased substantially during 1999–2007. The authors found that 73.4% of the HCV-related deaths occurred among persons aged 45–64 years, with a median age of death of 57 years, which is approximately 20 years less than the average lifespan of persons living in the US. Finally, HCV infection has been shown to impose a high economic burden on US health care systems, individuals and society. In fact, recent simulation studies have estimated that the clinical and economic burden of HCV will continue to increase over the next two decades. Despite this tremendous burden, the vast majority of HCV-infected patients remain undiagnosed and therefore not appropriately managed. Because persons aged 45–64 years are found to have a disproportionately higher prevalence of HCV infection and related disease, the CDC has recently augmented previous recommendations for risk-based HCV testing and now recommends one-time testing without prior ascertainment of HCV risk for persons born during 1945–1965. In addition, the US Preventative Services Task Force (USPSTF) recently supported the CDC's position and granted a B recommendation for birth cohort screening. USPSTF recommends HCV screening in persons at increased risk and one-time screening in adults born between 1945 and 1965.
Despite the daunting statistics surrounding HCV-associated disease, better treatment regimens are rapidly becoming available. The addition of direct-acting anti-viral agents to the therapeutic armamentarium has generated excitement among health care practitioners. Furthermore, the long sought after interferon-free HCV regimens for all HCV genotypes are in development and on the horizon. Given the new developments in HCV screening and new anti-viral regimens, it is increasingly important to assess the full impact of HCV burden in an evidence-based manner. Our aim was to present the summary of a Workshop from an Expert Panel who recently examined the literatures evaluating the total impact of HCV in an evidence-based approach.
Abstract and Introduction
Abstract
Background. Infection with the hepatitis C virus (HCV) has been considered a major cause of mortality, morbidity and resource utilisation in the US. In addition, HCV is the main cause of hepatocellular cancer (HCC) in the US. Recent developments in the diagnosis and treatment of HCV, including new recommendations pertaining to screening for HCV by the Centers for Disease Control and Prevention and newer treatment regimens with high efficacy, short duration and the potential for interferon-free therapies, have energised the health care practitioners regarding HCV management.
Aim. To assess the full impact of HCV burden on clinical, economic and patient-reported outcomes.
Methods. An expert panel was convened to assess the full impact of HCV burden on a number of important outcomes using an evidence-based approach predicated on Grading of Recommendations Assessment, Development and Evaluation methodology. The literature was summarised, graded using an evidence-based approach and presented during the workshop. Workshop presentations were intended to review recent, relevant evidence-based literature and provide graded summary statements pertaining to HCV burden on topics including the relationships between HCV and the development of important outcomes.
Results. The associations of HCV with cirrhosis, HCC, liver-related mortality, type 2 diabetes mellitus, rheumatological diseases and quality of life impairments are supported by strong evidence. Also, there is strong evidence that sustained viral eradication of HCV can improve important outcomes such as mortality and quality of life.
Conclusions. The current evidence suggests that HCV has been associated with tremendous clinical, economic and quality of life burden.
Introduction
In the US, hepatitis C virus (HCV)-associated disease has been considered the leading indication for liver transplantation and the leading cause of hepatocellular cancer (HCC). In addition to liver disease, HCV infection is suspected to be associated with a number of extrahepatic manifestations. Chronic hepatitis C and its sequelae are associated with increased cause-specific and overall mortality. A recent Centers for Disease Control and Prevention (CDC) review of death certificate data found that the hepatitis C mortality rate increased substantially during 1999–2007. The authors found that 73.4% of the HCV-related deaths occurred among persons aged 45–64 years, with a median age of death of 57 years, which is approximately 20 years less than the average lifespan of persons living in the US. Finally, HCV infection has been shown to impose a high economic burden on US health care systems, individuals and society. In fact, recent simulation studies have estimated that the clinical and economic burden of HCV will continue to increase over the next two decades. Despite this tremendous burden, the vast majority of HCV-infected patients remain undiagnosed and therefore not appropriately managed. Because persons aged 45–64 years are found to have a disproportionately higher prevalence of HCV infection and related disease, the CDC has recently augmented previous recommendations for risk-based HCV testing and now recommends one-time testing without prior ascertainment of HCV risk for persons born during 1945–1965. In addition, the US Preventative Services Task Force (USPSTF) recently supported the CDC's position and granted a B recommendation for birth cohort screening. USPSTF recommends HCV screening in persons at increased risk and one-time screening in adults born between 1945 and 1965.
Despite the daunting statistics surrounding HCV-associated disease, better treatment regimens are rapidly becoming available. The addition of direct-acting anti-viral agents to the therapeutic armamentarium has generated excitement among health care practitioners. Furthermore, the long sought after interferon-free HCV regimens for all HCV genotypes are in development and on the horizon. Given the new developments in HCV screening and new anti-viral regimens, it is increasingly important to assess the full impact of HCV burden in an evidence-based manner. Our aim was to present the summary of a Workshop from an Expert Panel who recently examined the literatures evaluating the total impact of HCV in an evidence-based approach.