Gane Edward, Stedman Catherine, Brunton Cheryl, Radke Sarah, Henderson Charles, Estes Chris, Razavi Homie
New Zealand Liver Transplant Unit, 15th Floor Support Building, Auckland City Hospital, Grafton, Auckland, New Zealand.
N Z Med J. 2014 Dec 19;127(1407):61-74.
We describe the burden of HCV infection and estimate the effect of four different treatment strategies to reduce HCV-related morbidity and mortality.
Baseline model parameters were based upon literature review and expert consensus, focusing on New Zealand data. Four scenarios were modelled: Scenario 1 estimated the impact of increased treatment efficacy, while Scenario 2 estimated the effect of increased treatment efficacy and gradual increases in numbers treated. Scenarios 3 and 4 estimated the impact of deferred introduction of new DAAs for either 1 or 2 years.
Prevalence of HCV infection peaked in 2010 (50,480 cases). Peak prevalence of cirrhosis and HCC will occur after 2030. Scenario 2 resulted in sizeable decreases in HCV-related morbidity and mortality. The impact of Scenario 1 was smaller. Deferring funding for new DAA treatments for a further 1 or 2 years resulted in an 18-36% increase in liver-related deaths in 2030.
While prevalence of chronic HCV infection may have peaked, disease burden continues to grow. Increased treatment uptake and efficacy combined with efforts to reduce disease transmission, will help prevent advanced liver disease and deaths.
我们描述了丙型肝炎病毒（HCV）感染的负担，并估计了四种不同治疗策略对降低HCV相关发病率和死亡率的影响。
基线模型参数基于文献综述和专家共识，重点关注新西兰的数据。模拟了四种情景：情景1估计了治疗效果提高的影响，而情景2估计了治疗效果提高和治疗人数逐渐增加的影响。情景3和情景4估计了推迟1年或2年引入新型直接抗病毒药物（DAA）的影响。
HCV感染患病率在2010年达到峰值（50480例）。肝硬化和肝癌的患病率峰值将在2030年之后出现。情景2导致HCV相关发病率和死亡率大幅下降。情景1的影响较小。将新型DAA治疗的资金再推迟1年或2年，会导致2030年肝脏相关死亡人数增加18%至36%。
虽然慢性HCV感染的患病率可能已达到峰值，但疾病负担仍在继续增加。增加治疗的可及性和疗效，同时努力减少疾病传播，将有助于预防晚期肝病和死亡。
