Australia could experience an increase in hepatitis C virus-related mortality and rising costs if current treatment options and their outcomes remain as they are, according to a data from a recent study.
Researchers conducted a literature review using data from Australia to determine new strategies to prevent rising HCV-related costs and liver disease. They created three treatment scenarios geared toward reducing HCV-related morbidity and mortality, based on a population of 233,490 patients with HCV, 13,850 with cirrhosis, 590 with hepatocellular carcinoma and 530 liver-related deaths. Scenario one evaluated the effect of an 80% to 90% increase by 2016 of treatment efficacy on the population. Scenario two evaluated an increase in treatment intake between 2,550 and 13,500 by 2018, without any treatment restriction. Scenario three used the same increases with treatment but with limitations on fibrosis stage 3 or greater from 2015 to 2017.
According to the results, the number of patients with cirrhosis and HCC and liver disease mortality will increase threefold by 2030 in the current treatment settings. Scenario one decreased HCV-related mortality by 4% by 2030; the number of people with chronic HCV declined by 5%; and patients with compensated and decompensated cirrhosis and HCC all decreased by 4%. Costs were estimated at 305 million Australian dollars ($283 million) by 2030, a 4% reduction from the base case. In scenario two, chronic HCV decreased by 60% without fibrosis score restriction compared with the base case. HCC decreased by 45%, compensated and decompensated cirrhosis decreased by 52% and 42%, respectively. Cumulative costs from 2013 to 2030 showed a 24% decrease, with an estimate of AU$3.75 billion. In scenario three, the HCV-infected population decreased by 56% when treatment was restricted to fibrosis stage 3 or more between 2015 and 2017, but then unrestricted from 2018. HCV-related deaths decreased by 52%, compensated cirrhosis cases decreased by 56%, decompensated cirrhosis cases decreased by 54% and HCC decreased by 51% vs. the base case. Annual costs in 2030 showed a 55% decrease from the base case, estimated to be AU$143 million.
“Large increases in the annual treated population, in addition to increased treatment efficacy, had a much larger impact on HCV prevalence, rates of HCC and liver-related mortality and costs compared with a scenario that considered increased treatment efficacy alone,” the researchers wrote. “Restricting treatment eligibility for a short time to those with advanced fibrosis may provide a clear path to eventual eradication of HCV infection in Australia.”
Disclosure: Relevant financial disclosures were not provided by researchers.