Impact of HCV Treatment on HCC and Liver-Related Mortality
Impact of HCV Treatment on HCC and Liver-Related Mortality
The model estimated that there were 144,000 (95% UI: 103,000–174,000) viraemic cases of HCV in England in 2013 (Figure 2A). The age distribution in 2013 is shown in Figure 2B and estimates for treatment and diagnosis in 2013 are shown in Table 3.
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Figure 2.
Outputs from the base case. The number of viraemic cases of HCV in England from 1950 to 2030 (A) and the age distribution of viraemic cases in England in 2013 (B).
Peak viraemic prevalence of chronic HCV infection was reached in 2007 with 153,000 infected individuals. Since then, the model suggested a decline in overall prevalence reaching an estimated 76,300 in 2030 (Table 4). Due to the lag between infection and the onset of HCV-related hepatic complications, the number of cases of compensated cirrhosis is projected to peak in 2029 at 14,800, increasing from 9,500 in 2013 (Table 4). The population with decompensated cirrhosis is estimated to increase from 860 in 2013 and peak in 2029 at 1400 cases. The number of individuals with HCV-related HCC is projected to increase from 410 in 2013 to 880 in 2030 (Table 4). Unless current practices of care in England change, the model forecasts that liver-related mortality will increase by 90% to 740 by 2030 (Table 4).
Table 5 compares the impact of increasing diagnosis and treatment of HCV as new therapies become available compared to continuing with the current strategy. In the latter case, the model predicts a total of 122,000 viraemic cases of HCV in 2020. Improving diagnostic and treatment rates by a total of 140% and 115% in 2018 respectively, would reduce the number of cases by 30% to 89,400 (Figure 3A).
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Figure 3.
HCV-related morbidity and mortality from 2013 to 2020. The impact of increasing diagnosis and treatment of HCV compared to the base-case scenario on the total number of infected cases (A), the number of patients with HCV-related fibrosis (B), HCV-related cirrhosis (C), HCV-infected decompensated cirrhosis (D), HCV-related HCC (E) and the number of liver-related deaths caused by HCV (F) is illustrated. Sensitivity analyses - the effect of different treatment options on HCV-related HCC and mortality.
Similarly, by increasing diagnosis and treatment, the number of HCV-related fibrosis cases in 2020 would decrease by 20% compared to the base case from 107,000 to 83,500 (Figure 3B). The number of patients with HCV-related cirrhosis and decompensated cirrhosis in 2020 would also decrease compared to base case, declining from 12,600 to 4,850 cases (60% reduction) and from 1,140 to 410 cases (65% reduction) respectively (Figure 3C and D). Meanwhile, the number of HCV-related HCC cases would decline from 640 to 310, a 50% reduction (Figure 3E). Finally, liver-related deaths caused by HCV would decrease by 50% from 570 to 280 cases in 2020 (Figure 3F).
Monte Carlo analysis identified the range around the prevalence estimate as the largest driver of uncertainty in the model, accounting for 95% of explained variability. The results of the sensitivity analyses are shown in Table 6. Changes in the number of treated patients (from 12,000 annually to 3,000 annually) had the largest impact on HCC cases and HCV liver-related deaths in 2020. The disease state of treated patients (treating all ≥ F1 patients) and the age of the treated patients considered eligible for treatment (limiting to patients ≤69 years) showed the next largest impact on HCC cases and HCV liver-related deaths in 2020.
Results
Base Case
The model estimated that there were 144,000 (95% UI: 103,000–174,000) viraemic cases of HCV in England in 2013 (Figure 2A). The age distribution in 2013 is shown in Figure 2B and estimates for treatment and diagnosis in 2013 are shown in Table 3.
(Enlarge Image)
Figure 2.
Outputs from the base case. The number of viraemic cases of HCV in England from 1950 to 2030 (A) and the age distribution of viraemic cases in England in 2013 (B).
Peak viraemic prevalence of chronic HCV infection was reached in 2007 with 153,000 infected individuals. Since then, the model suggested a decline in overall prevalence reaching an estimated 76,300 in 2030 (Table 4). Due to the lag between infection and the onset of HCV-related hepatic complications, the number of cases of compensated cirrhosis is projected to peak in 2029 at 14,800, increasing from 9,500 in 2013 (Table 4). The population with decompensated cirrhosis is estimated to increase from 860 in 2013 and peak in 2029 at 1400 cases. The number of individuals with HCV-related HCC is projected to increase from 410 in 2013 to 880 in 2030 (Table 4). Unless current practices of care in England change, the model forecasts that liver-related mortality will increase by 90% to 740 by 2030 (Table 4).
The Impact in 2020 of Increasing Diagnosis and Treatment of HCV
Table 5 compares the impact of increasing diagnosis and treatment of HCV as new therapies become available compared to continuing with the current strategy. In the latter case, the model predicts a total of 122,000 viraemic cases of HCV in 2020. Improving diagnostic and treatment rates by a total of 140% and 115% in 2018 respectively, would reduce the number of cases by 30% to 89,400 (Figure 3A).
(Enlarge Image)
Figure 3.
HCV-related morbidity and mortality from 2013 to 2020. The impact of increasing diagnosis and treatment of HCV compared to the base-case scenario on the total number of infected cases (A), the number of patients with HCV-related fibrosis (B), HCV-related cirrhosis (C), HCV-infected decompensated cirrhosis (D), HCV-related HCC (E) and the number of liver-related deaths caused by HCV (F) is illustrated. Sensitivity analyses - the effect of different treatment options on HCV-related HCC and mortality.
Similarly, by increasing diagnosis and treatment, the number of HCV-related fibrosis cases in 2020 would decrease by 20% compared to the base case from 107,000 to 83,500 (Figure 3B). The number of patients with HCV-related cirrhosis and decompensated cirrhosis in 2020 would also decrease compared to base case, declining from 12,600 to 4,850 cases (60% reduction) and from 1,140 to 410 cases (65% reduction) respectively (Figure 3C and D). Meanwhile, the number of HCV-related HCC cases would decline from 640 to 310, a 50% reduction (Figure 3E). Finally, liver-related deaths caused by HCV would decrease by 50% from 570 to 280 cases in 2020 (Figure 3F).
Sensitivity Analyses
Monte Carlo analysis identified the range around the prevalence estimate as the largest driver of uncertainty in the model, accounting for 95% of explained variability. The results of the sensitivity analyses are shown in Table 6. Changes in the number of treated patients (from 12,000 annually to 3,000 annually) had the largest impact on HCC cases and HCV liver-related deaths in 2020. The disease state of treated patients (treating all ≥ F1 patients) and the age of the treated patients considered eligible for treatment (limiting to patients ≤69 years) showed the next largest impact on HCC cases and HCV liver-related deaths in 2020.