Meijerink Hinta, White Richard A, Løvlie Astrid, de Blasio Birgitte Freiesleben, Dalgard Olav, Amundsen Ellen J, Melum Espen, Kløvstad Hilde
Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway.
European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden.
BMC Infect Dis. 2017 Aug 3;17(1):541. doi: 10.1186/s12879-017-2631-2.
Lack of Hepatitis C virus (HCV) incidence data in (Norwegian) high-risk groups impedes the ability to make informed decisions on prevention measures. Thus we rely on modelling to estimate the incidence and burden of HCV infections.
We constructed a compartmental model for HCV infections in Norway among active and former people who inject drugs (PWIDs). We based yearly transition rates on literature. The model was fitted to absolute numbers of hepatitis C associated cirrhosis, hepatocellular carcinoma (HCC) and death from national data sources (2000-2013). We estimated the number (95%CI) of HCV infections, cirrhosis, HCC and death and disability adjusted life years (DALYs) due to HCV infections in Norway, 1973-2030. We assumed treatment rates in the projected period were similar to those in 2013.
The estimated proportion of chronic HCV (including those with cirrhosis and HCC) among PWIDs was stable from 2000 (49%; 4441/9108) to 2013 (43%; 3667/8587). We estimated that the incidence of HCV among PWIDs was 381 new infections in 2015. The estimated number of people with cirrhosis, HCC, and liver transplant was predicted to increase until 2022 (1537 people). DALYs among active PWIDs estimated to peak in 2006 (3480 DALYs) and decrease to 1870 DALYs in 2030. Chronic HCV infection contributes most to the total burden of HCV infection, and peaks at 1917 DALYs (52%) in 2007. The burden of HCV related to PWID increased until 2006 with 81/100,000 DALYs inhabitants and decreased to 68/100,000 DALYs in 2015.
The burden of HCV associated with injecting drug use is considerable, with chronic HCV infection contributing most to the total burden. This model can be used to estimate the impact of different interventions on the HCV burden in Norway and to perform cost-benefit analyses of various public health measures.
（挪威）高危人群中丙型肝炎病毒（HCV）发病率数据的缺乏阻碍了就预防措施做出明智决策的能力。因此，我们依靠建模来估计HCV感染的发病率和负担。
我们构建了一个挪威活跃和既往注射吸毒者（PWID）中HCV感染的房室模型。我们根据文献确定年度转移率。该模型与来自国家数据源（2000 - 2013年）的丙型肝炎相关肝硬化、肝细胞癌（HCC）及死亡的绝对数字进行拟合。我们估计了1973 - 2030年挪威HCV感染、肝硬化、HCC及死亡和因HCV感染导致的伤残调整生命年（DALY）的数量（95%可信区间）。我们假设预测期内的治疗率与2013年相似。
2000年（49%；4441/9108）至2013年（43%；3667/8587），PWID中慢性HCV（包括伴有肝硬化和HCC者）的估计比例保持稳定。我们估计2015年PWID中HCV的发病率为381例新感染。预计到2022年（1537人），肝硬化、HCC及肝移植患者的估计数量将会增加。活跃PWID中的DALY估计在2006年达到峰值（3480 DALY）并在2030年降至1870 DALY。慢性HCV感染对HCV感染的总负担贡献最大，并在2007年达到峰值1917 DALY（52%）。与PWID相关的HCV负担在2006年之前一直增加，达到每10万居民81 DALY，并在2015年降至每10万居民68 DALY。
与注射吸毒相关的HCV负担相当大，慢性HCV感染对总负担的贡献最大。该模型可用于估计不同干预措施对挪威HCV负担的影响，并对各种公共卫生措施进行成本效益分析。
