Health Economics and Outcomes Research Ltd, Cardiff, UK.
Health Economics and Outcomes Research Ltd, Cardiff, UK; Department of Public Health, University of Adelaide, Australia; School of Medicine, University of Nottingham, UK.
Public Health. 2016 Dec;141:42-51. doi: 10.1016/j.puhe.2016.08.002. Epub 2016 Sep 16.
The hepatitis C virus (HCV) remains a significant public health issue. This study aimed to quantify the clinical and economic burden of chronic hepatitis C in the UK, stratified by disease severity, age and awareness of infection, with concurrent assessment of the impact of implementing a treatment prioritization approach.
A previously published back projection, natural history and cost-effectiveness HCV model was adapted to a UK setting to estimate the disease burden of chronic hepatitis C and end-stage liver disease (ESLD) between 1980 and 2035. A published meta-regression analysis informed disease progression, and UK-specific data informed other model inputs.
At 2015, prevalence of chronic hepatitis C is estimated to be 241,487 with 22.20%, 33.72%, 17.22%, 16.67% and 10.19% of patients in METAVIR stages F0, F1, F2, F3 and F4, respectively, but is estimated to fall to 193,999 by 2035. ESLD incidence is predicted to peak in 2031. Assuming all patients are diagnosed and treatment is prioritized in F3 and F4 using highly efficacious direct-acting antiviral (DAA) regimens, a 69.85% reduction in ESLD incidence is predicted between 2015 and 2035, and the cumulative discounted medical expenditure associated with the lifetime management of incident ESLD events is estimated to be £1,202,827,444.
The prevalence of chronic hepatitis C is expected to fall in coming decades; however, the ongoing financial burden is expected to be high due to an increase in ESLD incidence. This study highlights the significant costs of managing ESLD that are likely to be incurred without the employment of effective treatment approaches.
丙型肝炎病毒（HCV）仍然是一个重大的公共卫生问题。本研究旨在量化英国慢性丙型肝炎的临床和经济负担，按疾病严重程度、年龄和感染意识进行分层，并同时评估实施治疗优先排序方法的影响。
我们对以前发表的回溯预测、自然史和成本效益 HCV 模型进行了调整，以评估英国 1980 年至 2035 年慢性丙型肝炎和终末期肝病（ESLD）的疾病负担。一项已发表的荟萃回归分析提供了疾病进展信息，而英国特有的数据则为其他模型输入提供了信息。
在 2015 年，慢性丙型肝炎的患病率估计为 241487 例，其中 METAVIR 分期 F0、F1、F2、F3 和 F4 的患者分别占 22.20%、33.72%、17.22%、16.67%和 10.19%，但预计到 2035 年将降至 193999 例。ESLD 的发病率预计将在 2031 年达到峰值。假设所有患者均被诊断出来，并在 F3 和 F4 中使用高效直接作用抗病毒（DAA）方案进行治疗优先排序，那么 2015 年至 2035 年 ESLD 的发病率预计将降低 69.85%，并且终生管理 ESLD 事件的累计折扣医疗支出预计将达到 1202827444 英镑。
在未来几十年，慢性丙型肝炎的患病率预计将会下降；然而，由于 ESLD 发病率的增加，预计仍将面临高昂的财政负担。本研究强调了在不采用有效治疗方法的情况下，管理 ESLD 可能带来的巨大成本。
