title: Public health impact of antiviral therapy for hepatitis C in the United States.
abstract: Despite dramatic improvements in antiviral therapy for hepatitis C, there is reason to believe that the uptake of antiviral therapy remains limited. The aims of this study were to determine the number of patients being treated with antiviral therapy in the U.S., to estimate the public health impact of these treatment patterns, and to identify barriers to treatment for patients with hepatitis C. Data on the number of new patient pegylated interferon prescriptions each year, from 2002-2007, was obtained from Wolters Kluwer Inc., which maintains an electronic audit of pharmacies nationwide. A Markov model was created of the population with chronic hepatitis C in the U.S. from 2002 to 2030, and was used to estimate the number of liver-related deaths caused by hepatitis C that will be prevented by current treatment patterns. The National Health and Nutrition Evaluation Survey (NHANES) Hepatitis C Follow-Up Questionnaire was used to investigate reasons for lack of treatment and to identify strategies for improving access. Approximately 663,000 patients received antiviral therapy between 2002 and 2007, and treatment rates appear to be declining. If this trend continues, only 14.5% of liver-related deaths caused by hepatitis C from 2002-2030 will be prevented by antiviral therapy. Results from the NHANES questionnaire suggest that the primary barrier to treatment is lack of diagnosis, with 69/133 (adjusted proportion 49%) of respondents previously unaware that they had hepatitis C.
  
  
  CONCLUSIONS
  Efforts to improve rates of diagnosis and treatment will be required if the future public health burden of hepatitis C is to be ameliorated.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI 48109, USA. mvolk@med.umich.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Volk
authors.forename: Rachel
authors.initials: R
authors.lastname: Tocco
authors.forename: Sameer
authors.initials: S
authors.lastname: Saini
authors.forename: Anna S F
authors.initials: AS
authors.lastname: Lok
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D017281:Cost of Illness; D005260:Female; D006526:Hepatitis C / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D008390:Markov Chains; D011634:Public Health; D014481:United States
chemical_list: D000998:Antiviral Agents