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.
Toronto General Hospital, ES9 408, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. murray.krahn@uhn.on.ca.
Murray
M
Krahn
John B
JB
Wong
Jenny
J
Heathcote
Linda
L
Scully
Leonard
L
Seeff
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