Can J Gastroenterol Hepatol. 2014 May;28(5):243-50. doi: 10.1155/2014/317623.
Chronic infection with hepatitis C virus (HCV) is a major cause of cirrhosis, hepatocellular carcinoma and liver transplantation.
To estimate the burden of HCV-related disease and costs from a Canadian perspective.
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.
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.
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.
慢性丙型肝炎病毒（HCV）感染是肝硬化、肝细胞癌和肝移植的主要原因。
从加拿大的角度估计 HCV 相关疾病的负担和成本。
使用系统动力学框架，作者在 1950 年至 2035 年期间量化了加拿大 HCV 感染人群、疾病进展和成本。具体来说，跟踪了 36 个假设的、按年龄和性别定义的队列，以确定 HCV 的流行率、并发症和直接医疗费用（不包括抗病毒药物的成本）。模型假设和成本是从文献中提取的，重点是加拿大的数据。尽管未来会有更有效的抗病毒药物，但没有假设抗病毒治疗会比目前的水平有所增加。
病毒血症丙型肝炎病例的估计流行率在 2003 年达到高峰，为 260,000 人（不确定区间为 192,460 至 319,880），到 2013 年达到 251,990 人（不确定区间为 177,890 至 314,800），预计到 2035 年将下降至 188,190 人（不确定区间为 124,330 至 247,200）。然而，晚期肝病的流行率正在上升。预计代偿性肝硬化（n=36,210）、失代偿性肝硬化（n=3380）、肝细胞癌（n=2220）和与肝脏相关的死亡（n=1880）的患者每年的高峰数量将出现在 2031 年至 2035 年之间。在此期间，预计将有 32,460 名 HCV 感染个体因肝脏相关原因死亡。与 HCV（不包括治疗）相关的总医疗保健成本预计将从 2013 年增加 60%，直到 2032 年达到峰值，其中大部分归因于肝硬化及其并发症（2032 年为 81%，2013 年为 56%）。2013 年 HCV 感染者的终生成本估计为 64694 加元。
尽管加拿大的 HCV 流行率正在下降，但晚期肝病病例和医疗保健成本仍在上升。这些结果将有助于疾病预测、资源规划和制定加拿大 HCV 的合理管理策略。
