Estimating the prognosis of hepatitis C patients infected by transfusion in Canada between 1986 and 1990.
OBJECTIVE
To develop a natural history model for chronic hepatitis C virus (HCV) infection to determine allocation of compensatory funds to Canadians who acquired HCV through the blood supply from 1986 through 1990.


METHODS
A Markov cohort simulation model for HCV prognosis was developed, using content experts, published data, posttransfusion look-back data, and a national survey.


RESULTS
The mortality rate in transfusees is high (46% at 10 years), although HCV-related deaths are rare. Only 14% develop cirrhosis at 20 years (95% confidence interval, 0%--44%), but 1 in 4 will eventually develop cirrhosis, and 1 in 8 will die of liver disease.


CONCLUSIONS
This unique application of Markov cohort simulation and epidemiologic methods provides a state-of-the-art estimate of HCV prognosis and has allowed compensation decisions to be based on the best available evidence.
Krahn
Murray
M
Toronto General Hospital, ES9 408, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. murray.krahn@uhn.on.ca.
Wong
John B
JB
Heathcote
Jenny
J
Scully
Linda
L
Seeff
Leonard
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017848:Blood-Borne Pathogens; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D035881:Compensation and Redress; D003625:Data Collection; D005355:Fibrosis / Q000191:economics / Q000209:etiology / Q000401:mortality; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D065227:Transfusion Reaction